Abstract:

The typical concept of endoscopic surgery is the performance of surgical procedures in the two major body cavities, the abdomen and thorax. To perform this, small incisions for the ports are needed to introduce optics and instruments. Typically, the optic and the instruments are introduced from different angles. The access itself is associated with a reduced trauma.

Authors:

Sung-Tao Ko, M.D., F.A.C.S., F.R.C.S.(C.)

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Abstract:

Minimal access surgery has revolutionized the practice of surgery. It has been shown that patients may experience less postoperative discomfort, shorter hospitalization, and quicker recuperation. The centerpiece of this revolution resides in the development of optical equipment which allowed the surgeon and his or her assistants to visualize on two-dimensional (2-D) monitors the site of the procedure to be performed. However, as techniques become more complicated, there is more need for accurate depth perception. In other surgical disciplines like neurosurgery, otorhynolaryngology, and microvascular surgery, for instance, magnification is used to perform fine manipulations; to prevent loss of depth perception, microscopes are binocular. They permit stereoscopic vision with accurate depth perception. We have used and evaluated a three-dimensional (3-D) videocamera system, designed for laparoscopy, in an in vitro situation, in the experimental laboratory and clinically, and we report our experience in this chapter. We also discuss the rationale for use of 3-D video systems.

Authors:

Sung-Tao Ko, M.D., F.A.C.S., F.R.C.S.(C.)

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Abstract:

Laparoscopic cholecystectomy (LC) has become the standard treatment for removing a diseased gallbladder. Endoscopic surgical techniques are used to perform appendectomies, bowel resections, and gastrectomies. This minimally invasive surgery is favored because it decreases the patients' postoperative pain and length of hospitalization. However the incidence of complications with this technique is not negligible. As a new technique is evolving, the potential for complications is high. This increase in complication rate is undoubtedly due to inexperience during the initial phase of the surgeon's learning curve. Demand for the procedure has required rapid training and credentialing of many surgeons with limited experience in endoscopy and the use of instruments that allow only limited viewing of abdominal structures.

Authors:

Kazuya Kato, M.D., Ph.D., Minoru Matsuda, M.D. Ph.D., Masato Imai, M.D., Ph.D., Schinichi Kasai, M.D., Ph.D., Michio Mito, M.D., Ph.D.

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Abstract:

In breast cancer treatment axillary lymphadenectomy remains essential and necessary because of its role in prognosis and in treatment. Lymphatic nodal involvement is the most important finding for prognosis and indicates the necessity of adjuvant chemotherapy. Axillary lymphadenectomy decreases the risk of local and/or regional recurrence, but it does not modify the survival rate. Unfortunately, axillary lymphadenectomy has a high morbidity rate, despite all improvements made in the last decades. The conventional surgical technique removes the intact axillary content, preserving large vascular and nervous elements, but destroys a certain amount of small arteries, veins, lymphatics and nerves. This leads to complications such as lymphorrhea and edema, hypoaesthesia, shoulder stiffness, pain, deformity of the axilla, long and unaesthetic scars and the most disabling of all, arm swelling.

Authors:

Francois Suzanne, M.D., Chantal Emering, M.D., Arnaud Wattiez, M.D., Maurice Antoine Bruhat, M.D.

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Abstract:

The use of a balloon as a dissecting tool was pioneered by Gauer and Kieturakis in the early 1990s. This newapplication of balloon dissection in surgery allows the creation of a working space in which a procedure is performed. This is combined with minimally invasive techniques that confer the advantages of shorter recovery and less pain for several different procedures.

Authors:

J. Stephen Scott, M.D. General Surgeon, Private Practice Doctors Hospital, Roger A. de la Torre, M.D. General Surgeon, Chief of Surgery Doctors Hospital Wentzville, Missouri, Norbert L. Richardson, M.D. General Surgeon, Private Practice St. John's Mercy Hospital, Donna T. Richardson, M.D. general Surgeon, Private Practice St. John's Mercy Hospital Washington, Missouri

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