Laparoscopic Liver, Pancreas, and Biliary Surgery E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1091

Veröffentlichungsjahr: 2016

Beschreibung

Laparoscopic Liver, Pancreas and Biliary Surgery: Textbook and Illustrated Video Atlas is the perfect learning tool for all surgeons managing patients requiring advanced liver, pancreas and biliary surgery minimally invasively.

This highly immersive text and video atlas will provide surgeons from trainee to advanced levels of practice, including, general surgeons, hepato-pacreatico-biliary surgeons, transplant surgeons and surgical oncologists, with a step-by-step, multi-media teaching atlas on performing laparoscopic liver surgery, anatomically correct, safely and effectively.

The atlas will teach the surgeons to perform anatomic liver resections of each liver segment expertly and logically, and will cover lobectomies, extended resections, advanced laparoscopic pancreas surgery (including Whipple) and other procedures. A special emphasis is placed on reproducibility of excellence in surgical technique.

Each video will be supported by outstanding illustrations for each technique and 3D renderings of the relevant anatomy. The educational step-by step high-definition videos teach everything you need to know, including critical aspects like patient positioning, port placement, dissection and much more.

Led by the pioneers in laparoscopic liver, pancreas and biliary surgery, Brice Gayet and Claudius Conrad, the textbook-chapters will be authored by world experts and will contain surgical tips and tricks garnered from their unique experiences, to improve care, management of complications, relevant society guidelines and excellence in oncologic care for patients with hepato-pancreato-biliary cancers.

Leseprobe

Contents

Cover

Series Page

Title Page

Copyright

List of Contributors

Foreword by Norihiro Kokudo

Foreword by Keith D. Lillemoe

Foreword by Jean-Nicolas Vauthey

Preface by Brice Gayet

Preface by Claudius Conrad

Acknowledgments

About the Companion Website

Part I: Textbook

Section 1: General Considerations for Advanced Laparoscopic Hepatopancreatobiliary Surgery

Chapter 1: The Development of Minimal Access Hepatopancreatobiliary Surgery

1.1 Beginnings

1.2 Advent of Laparoscopy

1.3 Laparoscopic Hepatopancreatobiliary (HPB) Surgery

1.4 Laparoscopic Ultrasound in Liver and Pancreatic Surgery

1.5 Conclusion

References

Chapter 2: Acquisition of Specific Laparoscopic Skills for Laparoscopic Hepatopancreatobiliary Surgery

2.1 Introduction

2.2 What Skills and/or Requirements are Needed for Laparoscopic Liver and Pancreatic Surgery?

2.3 Conclusion

References

Chapter 3: Optimal Operating Room Set-Up and Equipment Used in Laparoscopic Hepatopancreatobiliary Surgery

3.1 Introduction

3.2 Operating Room Set-Up

3.3 Imaging System

3.4 Abdominal Entry and Closure

3.5 Energy Devices

3.6 Nonenergy Devices

3.7 Endoscopic Stapler

3.8 Tissue Removal Bag

3.9 Hemostatic Agent

References

Chapter 4: Augmented Reality for Laparoscopic Liver Surgery

4.1 Introduction

4.2 Augmented Reality

4.3 How is Augmented Reality Achieved?

4.4 Application of Augmented Reality for Laparoscopic Hepatopancreatobiliary Surgery

4.5 Challenges

4.6 The Future of Augmented Reality for Laparoscopic Liver Surgery

References

Chapter 5: Imaging of Hepatopancreatobiliary Diseases

5.1 Overview of Available Imaging Modalities

5.2 Organ-Specific Imaging

References

Chapter 6: Role of Staging Laparoscopy in Hepatopancreatobiliary Malignancies

6.1 Indications for Staging Laparoscopy

6.2 Technique of Staging Laparoscopy

6.3 Extended Staging Laparoscopy

6.4 Yield of Staging Laparoscopy

6.5 Timing of Staging Laparoscopy: Single Versus Two Stage

6.6 Complications of Staging Laparoscopy

6.7 Role of Staging Laparoscopy in Pancreatic and Hepatobiliary Malignancies

6.8 Summary and Future of Staging Laparoscopy in Pancreatic and Hepatobiliary Malignancies

References

Chapter 7: Interventional Radiology in the Management of Hepatopancreatobiliary Malignancy and Surgical Complications

7.1 Diagnosis

7.2 Interventional Radiology Management of Postoperative Complications

7.3 Image-Guided Locoregional Therapy of Hepatobiliary-Pancreatic Malignancy

7.4 Palliation

7.5 Conclusion

References

Chapter 8: Robotic Hepatopancreatic Surgery

8.1 Introduction

8.2 Robotic-Assisted Liver Surgery

8.3 Robotic-Assisted Pancreatic Surgery

8.4 Laparoscopic-Assisted Robotic Distal Pancreatectomy

8.5 Conclusion

References

Chapter 9: Enhanced Recovery After Hepatopancreatobiliary Surgery

9.1 Introduction

9.2 Fast-Track Liver Surgery

9.3 Fast-Track Pancreas Surgery

References

Section 2: Advanced Laparoscopic Hepatobiliary Surgery

Chapter 10: Relevant Hepatobiliary Anatomy

10.1 Introduction

10.2 Basic Liver Anatomy

10.3 Anatomy for Hemihepatectomy

10.4 Anatomy for Hepatic Segmentectomy

10.5 Anatomy for Caudate Lobe Resection

10.6 Important Points

10.7 Conclusion

References

Chapter 11: Anesthesia for Laparoscopic Liver Surgery

11.1 Introduction

11.2 Liver Pathophysiology

11.3 Physiology of Pneumoperitoneum

11.4 Preoperative Assessment

11.5 Anesthetic Management

11.6 Blood Loss and Preventive Strategies

11.7 Complications

11.8 Postoperative Recovery

References

Chapter 12: Oncological Management of Primary Liver Cancer in the Era of Minimal Access Surgery

12.1 Introduction

12.2 Hepatocellular Carcinoma

12.3 Biliary Tract Cancers

12.4 Conclusion

References

Chapter 13: Oncological Management of Colorectal Liver Metastases in the Era of Minimal Access Surgery

13.1 Introduction

13.2 Selection Criteria for Resection of Colorectal Cancer Liver Metastases

13.3 Conversion Chemotherapy for Unresectable Colorectal Cancer Liver Metastases

13.4 Neoadjuvant and Adjuvant Chemotherapy for Initially Resectable Colorectal Cancer Liver Metastases

13.5 Surgical Considerations Related to Preoperative Chemotherapy

13.6 Future Directions

13.7 Conclusion

References

Chapter 14: Resection of Noncolorectal Liver Metastases

14.1 Introduction

14.2 Neuroendocrine Liver Metastases

14.3 Noncolorectal, Nonneuroendocrine Liver Metastases

References

Chapter 15: Intraoperative Laparoscopic Ultrasound for Laparoscopic Hepatopancreatobiliary Surgery

15.1 Introduction

15.2 Technical Requirements for Laparoscopic Intraoperative Ultrasonography

15.3 Laparoscopic Ultrasonography for Liver Resection

15.4 Laparoscopic Ultrasonography for Pancreas Surgery

15.5 Laparoscopic Ultrasonography for Biliary Surgery

References

Chapter 16: Indications and Contraindications

16.1 Introduction

16.2 General Comments

16.3 Aim 1: Safe

16.4 Aim 2: Effective

16.5 Aim 3: Patient Centered

16.6 Aim 4: Efficient

16.7 Aim 5: Equitable

16.8 Aim 6: Timely

16.9 Conclusion

References

Chapter 17: Laparoscopy (Hybrid) and Hand-Assisted Laparoscopy in Liver Surgery: Why, When, and How?

17.1 Introduction

17.2 The Hybrid Technique (Laparoscopy-Assisted Method)

17.3 Hand-Assisted Laparoscopy

17.4 Conclusion

References

Chapter 18: Ablation Strategies for Tumors of the Liver and Pancreas

18.1 Overview of Modalities

18.2 Ablation of Hepatocellular Carcinoma

18.3 Ablation of Liver Metastases

18.4 Postablation Follow-Up

18.5 Treatment Approach: Percutaneous, Laparoscopic or Open?

18.6 Ablation of Pancreatic Tumors

References

Chapter 19: Technical Considerations for Advanced Laparoscopic Liver Resection

19.1 Introduction

19.2 General Considerations

19.3 Operative Technique

19.4 Conclusion

Chapter 20: Laparoscopic Left Lateral Sectionectomy and Left Hepatectomy for Living Donation

20.1 Introduction

20.2 Donor Evaluation Process

20.3 Surgical Technique

20.4 Postoperative Care

20.5 Conclusion and Future Perspectives

References

Section 3: Advanced Laparoscopic Pancreas Surgery

Chapter 21: Pancreatic Anatomy in the Era of Extensive and Less Invasive Surgery

21.1 Introduction

21.2 Basic Vascular Anatomy for Pancreatectomy (See Videos 20–26)

21.3 Pancreatic Anatomy for Organ-Preserving Peripancreatic Resection

References

Chapter 22: Management of Solid and Cystic Lesions of the Pancreas

22.1 Introduction

22.2 Solid Tumors of the Pancreas

22.3 Cystic Lesions of the Pancreas

References

Chapter 23: Laparoscopic Pancreatic Surgery

23.1 Introduction

23.2 Laparoscopic Distal Pancreatectomy

23.3 Pancreatic Enucleation

23.4 Laparoscopic Pancreaticoduodenectomy

23.5 Conclusion

References

Chapter 24: Indications and Contraindications for Laparoscopic Pancreas Surgery

24.1 Introduction

24.2 Indications, Contraindications, and Outcomes

References

Part II: Video Atlas

Section 1: Liver

Video 1: Intraoperative Ultrasonography for Safe Laparoscopic Livery Surgery

Left Lateral Sectionectomy

Right Hepatectomy

Segmentectomy of Segment VIII

Anatomy Figures

Posterior Superior Sectionectomy

Video 2: Left Lateral Sectionectomy

Anatomy Figures

Video 3: Left Lateral Sectionectomy Using a Laparoscopic Single Access Device

Anatomy Figures

Video 4: Segmentectomy I with Resection of Inferior Vena Cava

Anatomy Figures

Video 5: Segmentectomy IV

Anatomy Figures

Video 6: Segmentectomy IVA

Anatomy Figures

Video 7: Segmentectomy IVB

Anatomy Figures

Video 8: Bisegmentectomy IVB and V

Anatomy Figures

Video 9: Segmentectomy VI

Anatomy Figures

Video 10: Segmentectomy VII

Anatomy Figures

Video 11: Segmentectomy VIII (Transthoracic Access)

Anatomy Figures

Video 12: Left Hepatectomy

Anatomy Figures

Video 13: Right Hepatectomy

Anatomy Figures

Video 14: Left Trisegmentectomy With Caudate Lobectomy

Anatomy Figures

Video 15: Right Trisegmentectomy

Anatomy Figures

Video 16: Posterior Sectionectomy

Anatomy Figures

Video 17: Hilar Lymphadenectomy (With Right Hepatectomy and Caudate Lobectomy for Klatskin Tumor)

Anatomy Figures

Video 18: Mesohepatectomy

Acknowledgments

Anatomy Figures

Video 19: Living Donor Left Lateral Sectionectomy

Anatomy Figures

Section 2: Pancreas

Video 20: Total Splenectomy

Video 21: Partial Splenectomy

Video 22: Pancreatic Enucleation

Video 23: Cystgastrostomy

Video 24: Distal Pancreaticosplenectomy

Video 25: Spleen-Preserving Pancreatectomy of the Body and Tail

Video 26: Pancreaticoduodenectomy

Afterword by Beat Müller-Stich, Adrian T. Billeter, and Markus W. Büchler

Afterword by Pierre-Alain Clavien

Index

End User License Agreement

List of Tables

Table 5.1

Table 5.2

Table 5.3

Table 5.4

Table 5.5

Table 6.1

Table 6.2

Table 6.3

Table 6.4

Table 6.5

Table 6.6

Table 8.1

Table 8.2

Table 8.3

Table 8.4

Table 9.1

Table 9.2

Table 9.3

Table 10.1

Table 11.1

Table 12.1

Table 12.2

Table 13.1

Table 13.2

Table 14.1

Table 14.2

Table 14.3

Table 14.4

Table 14.5

Table 14.6

Table 14.7

Table 14.8

Table 15.1

Table 16.1

Table 16.2

Table 16.3

Table 21.1

Table 22.1

Table 22.2

Table 22.3

Table 22.4

Table 22.5

Table 23.1

Table 23.2

Table 24.1

Table 24.2

List of Illustrations

Figure 1.1

Figure 1.2

Figure 1.3

Figure 1.4

Figure 1.5

Figure 1.6

Figure 1.7

Figure 1.8

Figure 1.9

Figure 1.10

Figure 1.11

Figure 2.1

Figure 2.2

Figure 3.1

Figure 3.2

Figure 3.3

Figure 3.4

Figure 3.5

Figure 3.6

Figure 3.7

Figure 3.8

Figure 3.9

Figure 3.10

Figure 3.11

Figure 3.12

Figure 3.13

Figure 3.14

Figure 3.15

Figure 3.16

Figure 3.17

Figure 3.18

Figure 3.19

Figure 3.20

Figure 3.21

Figure 3.22

Figure 3.23

Figure 3.24

Figure 3.25

Figure 3.26

Figure 3.27

Figure 3.28

Figure 3.29

Figure 3.30

Figure 3.31

Figure 3.32

Figure 3.33

Figure 3.34

Figure 4.1

Figure 4.2

Figure 4.3

Figure 4.4

Figure 4.5

Figure 4.6

Figure 4.7

Figure 4.8

Figure 4.9

Figure 4.10

Figure 4.11

Figure 4.12

Figure 4.13

Figure 4.14

Figure 5.1

Figure 5.2

Figure 5.3

Figure 5.4

Figure 5.5

Figure 5.6

Figure 5.7

Figure 5.8

Figure 5.9

Figure 5.10

Figure 5.11

Figure 5.12

Figure 5.13

Figure 5.14

Figure 5.15

Figure 5.16

Figure 5.17

Figure 5.18

Figure 5.19

Figure 5.20

Figure 7.1

Figure 7.2

Figure 7.3

Figure 7.4

Figure 7.5

Figure 7.6

Figure 7.7

Figure 7.8

Figure 7.9

Figure 7.10

Figure 7.11

Figure 8.1

Figure 8.2

Figure 8.3

Figure 8.4

Figure 8.5

Figure 8.6

Figure 8.7

Figure 8.8

Figure 8.9

Figure 8.10

Figure 8.11

Figure 8.12

Figure 8.13

Figure 10.1

Figure 10.2

Figure 10.3

Figure 10.4

Figure 10.5

Figure 10.6

Figure 10.7

Figure 10.8

Figure 10.9

Figure 10.10

Figure 10.11

Figure 10.12

Figure 10.13

Figure 10.14

Figure 10.15

Figure 10.16

Figure 10.17

Figure 10.18

Figure 11.1

Figure 12.1

Figure 12.2

Figure 14.1

Figure 14.2

Figure 14.3

Figure 14.4

Figure 14.5

Figure 15.1

Figure 15.2

Figure 15.3

Figure 15.4

Figure 15.5

Figure 15.6

Figure 17.1

Figure 17.2

Figure 17.3

Figure 17.4

Figure 17.5

Figure 17.6

Figure 18.1

Figure 18.2

Figure 18.3

Figure 18.4

Figure 18.6

Figure 18.7

Figure 20.1

Figure 20.2

Figure 20.3

Figure 20.4

Figure 20.5

Figure 20.6

Figure 20.7

Figure 20.8

Figure 20.9

Figure 20.10

Figure 20.11

Figure 20.12

Figure 20.13

Figure 20.14

Figure 21.1

Figure 21.2

Figure 21.3

Figure 21.4

Figure 21.5

Figure 21.6

Figure 21.7

Figure 21.8

Figure 21.9

Figure 21.10

Figure 21.11

Figure 21.12

Figure 21.13

Figure 21.14

Figure 22.1

Figure 22.2

Figure 22.3

Figure 22.4

Figure 22.5

Figure 22.6

Figure 22.7

Figure 22.8

Figure 22.9

Figure 22.10

Figure 22.11

Figure 23.1

Figure 23.2

Figure 23.3

Figure 23.4

Figure 23.5

Figure 23.6

Figure 24.1

Figure 24.2

Figure 24.3

Figure v1.1

Figure v1.2

Figure v1.3

Figure v1.4

Figure v2.1

Figure v2.2

Figure v2.3

Figure v2.4

Figure v2.5

Figure v2.6

Figure v2.7

Figure v2.8

Figure v3.1

Figure v3.2

Figure v3.3

Figure v3.4

Figure v3.5

Figure v4.1

Figure v4.2

Figure v4.3

Figure v4.4

Figure v4.5

Figure v4.6

Figure v5.1

Figure v5.2

Figure v5.3

Figure v5.4

Figure v5.5

Figure v5.6

Figure v5.7

Figure v5.8

Figure v5.9

Figure v6.1

Figure v6.2

Figure v6.3

Figure v6.4

Figure v6.5

Figure v6.6

Figure v6.7

Figure v6.8

Figure v6.9

Figure v6.10

Figure v7.1

Figure v7.2

Figure v7.3

Figure v7.4

Figure v7.5

Figure v7.6

Figure v7.7

Figure v8.1

Figure v8.2

Figure v8.3

Figure v8.4

Figure v8.5

Figure v8.6

Figure v8.7

Figure v8.8

Figure v8.9

Figure v9.1

Figure v9.2

Figure v9.3

Figure v9.4

Figure v9.5

Figure v9.6

Figure v9.7

Figure v9.8

Figure v9.9

Figure v10.1

Figure v10.2

Figure v10.3

Figure v10.4

Figure v10.5

Figure v10.6

Figure v10.7

Figure v11.1

Figure v11.2

Figure v11.3

Figure v11.4

Figure v11.5

Figure v11.6

Figure v11.7

Figure v11.8

Figure v12.1

Figure v12.2

Figure v12.3

Figure v12.4

Figure v12.5

Figure v12.6

Figure v12.7

Figure v13.1

Figure v13.2

Figure v13.3

Figure v13.4

Figure v13.5

Figure v13.6

Figure v13.7

Figure v13.8

Figure v13.9

Figure v14.1

Figure v14.2

Figure v14.3

Figure v14.4

Figure v14.5

Figure v14.6

Figure v14.7

Figure v14.8

Figure v14.9

Figure v14.10

Figure v14.11

Figure v15.1

Figure v15.2

Figure v15.3

Figure v15.4

Figure v15.5

Figure v15.6

Figure v15.7

Figure v16.1

Figure v16.2

Figure v16.3

Figure v16.4

Figure v16.5

Figure v16.6

Figure v17.1

Figure v17.2

Figure v17.3

Figure v17.4

Figure v17.5

Figure v17.6

Figure v17.7

Figure v17.8

Figure v17.9

Figure v17.10

Figure v17.11

Figure v17.12

Figure v17.13

Figure v17.14

Figure v18.1

Figure v18.2

Figure v18.3

Figure v18.4

Figure v18.5

Figure v19.1

Figure v19.2

Figure v19.3

Figure v19.4

Figure v19.5

Figure v19.6

Figure v19.7

Figure v19.8

Figure v19.9

Figure v19.10

Figure v19.11

Figure v19.12

Figure v19.13

Figure v20.1

Figure v21.1

Figure v22.1

Figure v22.2

Figure v23.1

Figure v23.2

Figure v24.1

Figure v24.2

Figure v25.1

Figure v25.2

Figure v26.1

Figure v26.2

Figure v26.3

Figure v26.4

Figure v26.5

Figure v26.6

Figure v26.7

Figure v26.8

Guide

Cover

Table of Contents

Begin Reading

Part 1

Chapter 1

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Laparoscopic Liver, Pancreas, and Biliary Surgery is an essential learning tool for all surgeons who manage patients considered for minimally invasive liver, pancreas, and biliary surgery.

Led by Claudius Conrad and Brice Gayet, pioneers in laparoscopic liver, pancreas, and biliary surgery, the authors have created a highly focused and multi-dimensional tool that takes the surgeon through the surgical procedures, one step at a time. Using a combination of text, illustrations, and high-definition videos, the authors explain and illustrate their excellence in surgical technique in a detailed and reproducible fashion.

The textbook contains contributions from world renowned experts and thought leaders in the field. They discuss key management concepts in the oncologic management of patients undergoing minimally invasive liver, pancreas, and biliary resections.

The accompanying comprehensive video atlas contains high-definition videos with a focus on true anatomic resections. The videos are supported by outstanding illustrations and 3D renderings of the relevant anatomy.

The authors expertly and logically demonstrate how to perform anatomic and nonanatomic liver, pancreas, and biliary resections. They cover patient and port positioning for laparoscopic and robotic approaches, detailed anatomy, and didactic breakdown of the operation. Including numerous surgical tips and tricks, and practical reviews for the management of patients with liver, pancreas, and biliary diseases before, during, and after operations the volume covers:

Essential techniques (e.g. intraoperative ultrasound);

Segmentectomies (I-VIII) and bisegmentectomies;

Major hepatectomies, extended resections, and living donor liver transplantation;

Pancreatectomies (e.g. Whipple) and Biliary resections;

Advanced laparoscopic technologies and robotics.

This unparalleled resource will help a wide range of surgeons – including liver, pancreas, and biliary specialists, general surgeons, transplant surgeons, and surgical oncologists – to improve their surgical technique of both open and minimally invasive surgery.

Laparoscopic Liver, Pancreas, and Biliary Surgery

Edited By

Claudius Conrad MD, PhD

Department of Surgical OncologyUniversity of Texas MD Anderson Cancer CenterHouston, USA

Brice Gayet MD, PhD

Professor and Head, Medical and Surgical Department of Digestive DiseasesInstitut Mutualiste MontsourisParis, France

This edition first published 2017 © 2017 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Names: Conrad, Claudius, editor. | Gayet, Brice, editor.

Title: Laparoscopic liver, pancreas, and biliary surgery / edited by Claudius Conrad, Brice Gayet.

Description: Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons Inc., 2017. | Includes bibliographical references and index.

Identifiers: LCCN 2015046826 | ISBN 9781118781173 (cloth)

Subjects: | MESH: Liver Diseases–surgery | Pancreatic Diseases–surgery | Biliary Tract Surgical Procedures | Laparoscopy

Classification: LCC RD546 | NLM WI 770 | DDC 617.5/56–dc23 LC record available at http://lccn.loc.gov/2015046826

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover design by Nao Kusuzaki; Cover Photo by Claudius Conrad

List of Contributors

Anil K. Agarwal

Department of Gastrointestinal Surgery and Liver Transplant

Govind Ballabh Pant Hospital and Maulana Azad Medical College, Delhi University

New Delhi, India

Thomas A. Aloia

Department of Surgical Oncology

University of Texas MD Anderson Cancer Center

Houston, TX, USA

Camerlo Antoine

Digestive Surgery Department

European Hospital of Marseilles, France

Kenichiro Araki

Department of General Surgical Science

Gunma University Graduate School of Medicine

Gunma, Japan

Horacio J. Asbun

Department of General Surgery

Mayo Clinic

Jacksonville, FL, USA

Adrian T. Billeter

Department of General, Visceral, and Transplantation Surgery

University of Heidelberg Hospital

Heidelberg, Germany

Markus W. Büchler

Department of General, Visceral, and Transplantation Surgery

University of Heidelberg Hospital

Heidelberg, Germany

Hop S. Tran Cao

Department of Surgery

Baylor College of Medicine

Houston, TX, USA

Jennifer Chan

Department of Medical Oncology

Dana-Farber Cancer Institute, Harvard Medical School

Boston, MA, USA

Pierre-Alain Clavien

Klinik für Viszeral- und Transplantationschirurgie

UniversitätsSpital Zürich

Zürich, Switzerland

Claudius Conrad

Department of Surgical Oncology

University of Texas MD Anderson Cancer Center

Houston, TX, USA

Danielle K. DePeralta

Division of Surgical Oncology

Harvard Medical School

Massachusetts General Hospital

Boston, MA, USA

David Fogelman

Department of Gastrointestinal Medical Oncology

University of Texas MD Anderson Cancer Center

Houston, Texas, TX, USA

Kathryn J. Fowler

Department of Radiology

Washington University School of Medicine

St Louis, MO, USA

David Fuks

Department of Digestive Diseases

Institut Mutualiste Montsouris

Paris, France

Matteo Fusaglia

ARTORG Center for Biomedical Engineering Research

University of Bern

Bern, Switzerland

Kate Gavaghan

ARTORG Center for Biomedical Engineering Research

University of Bern

Bern, Switzerland

Brice Gayet

Department of Digestive Diseases

Institut Mutualiste Montsouris

Paris, France

Vijaya N.R. Gottumukkala

Department of Anesthesiology and Perioperative Medicine

University of Texas MD Anderson Cancer Center

Houston, TX, USA

Claire Goumard

Department of Hepatobiliary Surgery and Liver Transplantation

Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris

Paris, France

Mahendran Govindasamy

Salem Gastro, Salem

Tamil Nadu, India

Ho-Seong Han

Department of Surgery

Seoul National University College of Medicine

Gyeonggi-do, Korea

Yasushi Hasegawa

Department of Surgery

Iwate Medical University School of Medicine

Morioka, Japan

Steven Y. Huang

Department of Interventional Radiology, Division of Diagnostic Imaging

University of Texas MD Anderson Cancer Center

Houston, TX, USA

William R. Jarnagin

Hepatopancreatobiliary Service, Department of Surgery

Memorial Sloan-Kettering Cancer Center, New York, USA

Amit Javed

Department of Gastrointestinal Surgery and Liver Transplant

Govind Ballabh Pant Hospital and Maulana Azad Medical College, Delhi University

New Delhi, India

Raja Kalayarasan

Department of Gastrointestinal Surgery and Liver Transplant

Govind Ballabh Pant Hospital and Maulana Azad Medical College, Delhi University

New Delhi, India

Matthew H.G. Katz

Department of Surgical Oncology

University of Texas MD Anderson Cancer Center

Houston, TX, USA

Kimitaka Kogure

Institute for Molecular and Cellular Regulation

Gunma University

Gunma, Japan

Norihiro Kokudo

Hepatobiliary Pancreatic Surgery Division, Department of Surgery

Graduate School of Medicine, University of Tokyo

Tokyo, Japan

David A. Kooby

Department of Surgery

Emory University School of Medicine

Atlanta, GA, USA

Universe Leung

Hepatopancreatobiliary Service, Department of Surgery

Memorial Sloan-Kettering Cancer Center

New York, USA

Keith D. Lillemoe

Division of Surgical Oncology

Harvard Medical School

Massachusetts General Hospital

Boston, MA, USA

Guy Maddern

University of Adelaide Discipline of Surgery

Queen Elizabeth Hospital

Woodville South, Australia

Masatoshi Makuuchi

Department of Hepato-Biliary-Pancreatic Surgery

Japanese Red Cross Medical Center,

Tokyo, Japan

Soeren Torge Mees

University of Adelaide, Discipline of Surgery

The Queen Elizabeth Hospital

Woodville South, Australia

Yoshihiro Mise

Hepatobiliary Pancreatic Surgery Division, Department of Surgery

Graduate School of Medicine, University of Tokyo

Tokyo, Japan

Beat Müller-Stich

Department of General, Visceral, and Transplantation Surgery

University of Heidelberg Hospital

Heidelberg, Germany

Hanno Niess

Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery

Hospital of the University of Munich

Munich, Germany

Takeo Nomi

Department of Surgery

Nara Medical University

Nara, Japan

Satoshi Ogiso

Department of Digestive Diseases

Institut Mutualiste Montsouris

Paris, France

Nicolas Paleari

Department of General Surgery

Mayo Clinic

Jacksonville, FL, USA

Matthias Peterhans

ARTORG Center for Biomedical Engineering Research

University of Bern

Bern, Switzerland

Ruchir Puri

Department of General Surgery

Mayo Clinic

Jacksonville, FL, USA

Daniel Richard Rutz

Department of Surgery

Emory University School of Medicine

Atlanta, GA, USA

Yoshihiro Sakamoto

Hepatobiliary Pancreatic Surgery Division, Department of Surgery

Graduate School of Medicine, University of Tokyo

Tokyo, Japan

Olivier Scatton

Department of Hepatobiliary Surgery and Liver Transplantation

Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris

Paris, France

Hillary Shaw

Radia Inc., PS

Lynwood, WA, USA

Nairuthya Shivathirthan

Department of Surgical Gastroenterology

Apollo BGS Hospital

Mysore, India

John Stauffer

Department of General Surgery

Mayo Clinic

Jacksonville, FL, USA

Tadatoshi Takayama

Department of Digestive Surgery

Nihon University School of Medicine

Tokyo, Japan

Kenneth K. Tanabe

Division of Surgical Oncology

Harvard Medical School

Massachusetts General Hospital

Boston, MA, USA

Jean-Nicolas Vauthey

Department of Surgical Oncology

University of Texas MD Anderson Cancer Center

Houston, TX, USA

Go Wakabayashi

Department of Surgery

Ageo Central General Hospital

Ageo City, Japan

Michael J. Wallace

Department of Interventional Radiology, Division of Diagnostic Imaging

University of Texas MD Anderson Cancer Center

Houston, TX, USA

Stefan Weber

ARTORG Center for Biomedical Engineering Research

University of Bern

Bern, Switzerland

Jens Werner

Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery

Hospital of the University of Munich

Munich, Germany

Jonathan A. Wilks

Department of Anesthesiology and Perioperative Medicine

University of Texas MD Anderson Cancer Center

Houston, TX, USA

Robert A. Wolff

Department of Gastrointestinal Medical Oncology

University of Texas MD Anderson Cancer Center

Houston, TX, USA

Jeff Siu-Wang Wong

United Christian Hospital

Hong Kong

Motoyo Yano

Department of Radiology

Washington University School of Medicine

St Louis, MO, USA

Foreword

It is with great pleasure that I write this foreword for the textbook and video atlas by Claudius Conrad and Brice Gayet on laparoscopic hepatopancreatobiliary (HPB) surgery. Claudius Conrad, who trained in my department at the Graduate School of Medicine, University of Tokyo, and Brice Gayet, who is a frequent guest-surgeon to Japan, have proved to me and the surgical community their excellent surgical skills in both open and laparoscopic surgery and their paramount concern for patient safety with their laparoscopic approach. Consequently, Claudius and Brice are very well equipped in creating this teaching material that promotes safe laparoscopic HPB surgery.

Today, almost all forms of hepatic resections have been performed via a laparoscopic approach, ranging from simple wedge resections to extended hepatectomies or resections with advanced vascular reconstruction. Brice Gayet and his team have certainly contributed significantly to its progress since its inception. Most studies that evaluate laparoscopic liver resection have shown comparable results to open resection in terms of operative blood loss, postoperative morbidity, and mortality. Many have demonstrated decreased postoperative pain, shorter hospital stays, and even lower costs. Preliminary oncological results, including resection margin status and long-term survival, are not inferior to open resection, although solid evidence proving equivalence is not available today as prospective and randomized studies are lacking. At least 40 studies (with more than 30 patients) on laparoscopic liver resection for malignancy have been reported although most of these were case series or case-control studies only. A larger series was first reported in 2002 while the majority of reports have been published since 2009. Therefore, reports on the long-term outcomes are not currently available.

As with open surgery, hepatocellular carcinoma and colorectal metastasis are the main indications for malignant tumor resection in laparoscopic surgery. However, in the earlier reports, a significant proportion of lesions resected laparoscopically were benign and this raises concerns as to whether these benign lesions were in fact resected because laparoscopy was readily available and not because their removal was deemed a necessity. It is important to recognize that laparoscopic surgery is merely a technique and its availability should not change the indication for resection. Further, the laparoscopic approach should not lead to shortcuts in terms of quality of oncological surgery provided.

Both Claudius and Brice have shown the importance of parenchyma-sparing liver surgery and how anatomical liver resection can indeed increase the safety of liver surgery. These important concepts can be successfully applied to laparoscopic surgery but do require a significant laparoscopic skill set. I am confident that this book and video atlas will allow a greater number of surgeons to successfully apply these concepts which will further the success of this field of laparoscopic surgery.

Progress in surgery is of the utmost importance and it is apparent to me that laparoscopic surgery will play a crucial role in HPB surgery in the near future. This informative textbook and atlas provides the community of HPB surgeons with what is laparoscopically feasible but it also clearly advocates the importance of operative and oncological safety. I am delighted to see this work by expert laparoscopic surgeons Claudius Conrad and Brice Gayet. I wholeheartedly endorse this book as a significant learning tool for surgeons who wish to attain valuable insights and to improve their laparoscopic skills in HPB surgery.

Congratulations on your great achievements, Claudius and Brice!

Professor Norihiro KokudoDepartment of SurgeryUniversity of Tokyo HospitalTokyo, Japan

Foreword

As a “single-port, maximally invasive pancreatic surgeon,” I have dreaded the day when laparoscopic pancreatic surgery would reach the point that these techniques would be available at all hospitals, provided by a wide variety of surgeons for every possible indication in almost every patient. I have been steadfast in my assumption that for these complex operations, especially with aggressive/invasive pancreatic malignancies, the wide exposure and an experienced surgeon using traditional open techniques would always be able to provide a “better” cancer operation, with superior short- and long-term outcomes, than “the new kids on the block” with either laparoscopic or robotic skills but limited experience in pancreatic surgery. I felt that even if high-volume centers with highly skilled surgical teams from around the world could report equivalent outcomes to open surgery, the rest of the surgical community would never catch up and I could play out the rest of my career as a “dinosaur” pancreatic surgeon with excellent outcomes but big incisions.

Then I met Brice Gayet and Claudius Conrad, and saw this well-written, this beautifully illustrated, this novel textbook and video atlas. I am realizing that the skills are now available in the surgical community and that there are teachers, such as Brice Gayet and Claudius Conrad, who can not only teach the techniques of minimally invasive pancreas surgery, but can build the confidence and determination of the next generation of pancreatic surgeons to push this field faster and further towards widespread application.

This textbook/atlas has clearly defined the laparoscopic technique for every common pancreatic surgical procedure and beautifully demonstrated the “tricks of the trade” in both the illustrations and video format. This book will be an essential for every institution developing a minimally invasive program in pancreatic surgery, as well as for those individuals training in surgical oncology, HPB surgery, and transplant surgery who hope to practice using the modern techniques for HPB surgery in the future.

In closing, it is likely too late for me, but for those early and midcareer pancreatic surgeons, be prepared, as it appears the “cows are out of the barn” with respect to minimally invasive pancreatic surgery and we are unlikely to corral the herd again with such a supportive and educational training tool such as this textbook/atlas.

Keith D. Lillemoe MDSurgeon-in-ChiefChief, Department of SurgeryMassachusetts General HospitalW. Gerald Austen Professor of SurgeryHarvard Medical SchoolBoston, MA, USA

Foreword

Recent decades have seen tremendous progress in the treatment of patients with liver and pancreas diseases. The overarching theme of this progress is that treatment is becoming more tailored: less invasive when possible and more radical when necessary. This progress has been made possible in part by multidisciplinary innovations that support the work of the surgeon. For example, understanding of the mutational profile of the primary tumor and metastases not only allows for accurate prognostication but also enables surgeons to accurately determine which patients would benefit from undergoing extensive liver resections. Further, portal vein embolization via an interventional radiology approach has made portal vein ligation almost obsolete and allowed patients requiring major resection to be treated safely with hepatectomy. This minimal-access procedure has therefore enabled surgeons to perform more radical resections.

The community of minimally invasive hepatopancreatobiliary surgeons has also made significant strides towards reduce the morbidity of the surgery itself. Minimally invasive surgery for liver and pancreas diseases has progressed from a purely diagnostic procedure and minor resections of liver and pancreas to advanced procedures that include extended liver resections, pancreaticoduodenectomy, and vascular reconstructions. While diagnostic laparoscopy and minor laparoscopic liver and pancreas resections are practiced at many centers, advanced resections are limited to a select group of surgeons and a few institutions. The reason is that advanced skills in both hepatopancreatobiliary surgery and minimally invasive surgery are required to safely perform these advanced procedures. Mastery of both skills requires significant time investments in observerships, practice of laparoscopic technical skills, and creation of an infrastructure.

Brice Gayet and Claudius Conrad have created this important study material to facilitate learning these advanced procedures. In the video atlas, basic and advanced anatomic resections of liver and pancreas, many of which are challenging to master even via an open approach, are demonstrated in a didactically well-structured fashion. Three-dimensional renderings of the relevant liver anatomy, port positioning, and critical phases of the operation are depicted in wonderfully detailed images. The textbook provides the foundation in hepatopancreatobiliary oncology and the current data on minimally invasive hepatopancreatobiliary surgery necessary to set the illustrated video atlas in a conceptual framework. In the descriptions and the videos themselves we recognize the didactic skills of Claudius Conrad and Brice Gayet. The in-depth knowledge and technical skills demonstrated by Brice Gayet are not only rooted in his professorship of surgery but also in that of anatomy for many years.

I strongly recommend that everyone aspiring to master these skills use this work as a study guide on a routine basis. Mastery of the important theoretical concepts and internalization of the operative approaches presented in this work are needed for optimal outcomes. In addition, the excellent didactic set-up and the high-quality and beautiful operations presented in the video atlas make this work an excellent study tool for surgeons performing surgery via an open approach.

Congratulations to Brice Gayet and Claudius Conrad on this important study material that will facilitate mastery of the art of advanced minimally invasive hepatopancreatobiliary surgery!

Jean-Nicolas Vauthey MD, FACSChief, Hepato-Pancreato-Biliary SectionBessie McGoldrick Professor in Clinical Cancer ResearchMD Anderson Cancer CenterDepartment of Surgical OncologyMD Anderson Cancer CenterHouston, Texas

Preface

In the previous century, minimally invasive surgery was introduced to minimize trauma in gastrointestinal operations. After the first laparoscopic cholecystectomy, the indications for a laparoscopic approach increased significantly, particularly in colorectal surgery. Liver and pancreas surgery were initially thought to be unsuitable for laparoscopic techniques, due to the difficulties of safe mobilization and exposure. As a result, a significant number of experts in open hepaticopancreatobiliary surgery were reluctant to incorporate a laparoscopic approach into their practice and/or evaluate it in a randomized controlled trial.

Despite, and because of, significant advances in diagnostic, anesthesiological, and surgical technique that allowed for safer HPB surgery, these advances rarely became the bases for investigating how to make HPB surgery less invasive. This reluctance was rooted in the fear of losing the improvements the open HPB surgery community had achieved. Nevertheless, some expert centers reported on the feasibility and safety of laparoscopic HPB surgery and proved the benefits regarding reduced blood loss and pain, and improved recovery, compared to open liver surgery.

For open surgery, complete knowledge of HPB anatomy is essential. This is even more crucial when considering laparoscopic HPB surgery. For that reason, we have included two chapters on pancreas and liver anatomy by expert surgeons and anatomists from Japan, Drs Sakamoto and Takayama. These chapters will help to elucidate and safely reproduce the laparoscopic surgical techniques shown in the videos.

To date, two consensus conferences have been held on laparoscopic liver resections. One of the conclusions from the first consensus conference, held in 2009, was that laparoscopic resection of segments II and III should be considered the standard of care; the second conference in 2014 indicated that major resections were an innovative procedure, but still in an exploratory phase. An important conclusion by the consensus jury was that a “major focused effort is necessary to determine what laparoscopic skills are required by trainees and HPB surgeons to successfully perform major laparoscopic liver resections.” Claudius Conrad and I hope very much that this textbook and video atlas will help initiate or ease this learning curve.

The development of laparoscopy has also proved to be beneficial in pancreatic surgery, and laparoscopic distal pancreatectomy currently represents the standard of care. Other procedures, such as advanced enucleations, middle pancreatectomy or pancreatoduodenectomy, remain investigational. However, recent series on these advanced pancreatic procedures suggest that laparoscopy offers significant potential in reducing morbidity.

This atlas of minimally invasive HPB surgery has been designed as a high-quality, comprehensive didactic tool. A work of this magnitude could only be achieved by the input of experts from around the world who have extensive experience in treating HPB diseases and are established educators who have successfully mentored many young surgeons. In this atlas, we attempt to elucidate and provide an update on the surgical and perioperative management of HPB disorders from a laparoscopic point of view. Claudius Conrad and I have prepared the didactic videos for both trainees and specialized HPB surgeons in a comprehensive manner with an attempt to present the topics in an easy and understandable format.

What does the future hold for us? A state-of-the-art advancement, stereoscopic vision (3D), is the latest innovation that, in our experience, can significantly reduce both bleeding and operative time. As computer-assisted surgery in the operating room is implemented that includes not only robotics (co-manipulation, so-called cobot) but also cognitics (automated cognition), we can expect to see further improvement and progress in the safety and patient outcomes related to minimally invasive HPB procedures. Already today, patients' imaging studies are used for virtual 3D modeling and visualization of anatomical or pathological structures. In the future, the synthesis of these advances will allow us to create an augmented reality during surgery. The next step is likely the development of true robotic interfaces to improve safety and reduce operative time and automation of algorithms for a better understanding of operative scenarios and treatments.

The creation of this atlas was undoubtedly dependent on the support and enthusiasm of an expert team. Claudius Conrad and I wish to thank all the authors who agreed to participate in this educational work and share their vast experience. Finally, I would like to thank our editor and Claudius' editorial team at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Brice Gayet

Paris

Preface

On résiste à l'invasion des armées; on ne résiste pas à l'invasion des idées…

Victor Hugo

We live in exciting times. Hepato-pancreato-biliary (HPB) surgery is forging ahead into new territory. Those of us who aim to pioneer the field must be mindful of not only how novel its frontiers are but also, and more importantly, how valuable and how to extend ourselves to reach them. Surgeons are aiming to minimize the trauma of surgery, with the hopes of lowering morbidity, lessening time spent in hospital, potentially returning patients earlier to chemotherapy, or even improving long-term outcomes.

Because of the complexity of advanced HPB surgery, it was previously thought not to lend itself to minimally invasive surgery, but my coeditor, Brice Gayet, and others have shown us through their creativity and innovative work that the time for considering less invasive HPB surgery has come. I am delighted to be part of a community of surgeons aiming to advance the field of minimally invasive HPB surgery through reducing its morbidity and improving outcomes. My surgical mentors in Germany, the United States, Japan, and France have enabled me to make a meaningful contribution to this community, and I am very thankful to them for this.

With all of the excitement over the possibilities of laparoscopic HPB surgery, we must not forget its overarching goal, which is to obtain the best possible short- and long-term outcome for our patients. Since most patients undergo HPB surgery for cancer, it is paramount that oncological principles are observed if we are to ensure good outcomes. For that reason, it was important to me to ask international authorities in our field to contribute their expertise to this textbook and video atlas, since the best possible outcome can only be achieved if laparoscopic HPB surgery is put into the context of optimal oncological care. In addition to the contribution by these international experts, the camaraderie and the hard work of the international fellows at Institut Mutualiste Montsouris (IMM) were key in ensuring the success of this textbook and video atlas.

I hope very much that this textbook and video atlas will allow HPB surgeons to optimize outcome for their patients. I would like to thank Brice Gayet, our contributors, co-fellows at IMM, the editorial team, and, most importantly, my patients who have made this textbook and video atlas of laparoscopic hepato-pancreato-biliary surgery possible.

Claudius Conrad

Houston

Acknowledgments

We wish to thank the following people personally for their contributions to our inspiration and knowledge and other help in creating this book.

Dr Camerlo Antoine, Digestive Surgery Department, European Hospital of Marseilles, Marseilles, France.

Dr Kenichiro Araki, Division of Hepato-Biliary-Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan.

Kristine K. Ash, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.

Dr Mahendran Govindasamy, Salem Gastro, Salem, Tamil Nadu, India.

Nao Kusuzaki, Houston, USA.

Dr Takeo Nomi, Department of Surgery, Nara Medical University, Nara, Japan.

Dr Nairuthya Shivathirthan, Department of Surgical Gastroenterology, Apollo BGS Hospital, Mysore, India.

Storm Weaver PhD, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.

Dr Jeff Siu-Wang Wong, United Christian Hospital, Hong Kong, China.

Dr Y Nancy You, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.

Tom Bates, Angela Cohen, Pri Gibbons, Felicity Marsh, and Holly Regan-Jones at Wiley Blackwell.

About the Companion Website

This book is accompanied by a companion website:

www.wiley.com\go\conrad\liver-pancreas-biliary-laparoscopic-surgery

The website includes:

videos, with transcription

critical anatomy pictures

port positioning

important intraoperative pictures

important points.

How to access the site:

Access to the website requires a password. There is a prompt on the website about how to obtain the password.

Part ITextbook

Section 1General Considerations for Advanced Laparoscopic Hepatopancreatobiliary Surgery

Chapter 1The Development of Minimal Access Hepatopancreatobiliary Surgery

Ruchir Puri, Nicolas Paleari, John Stauffer, and Horacio J. Asbun

Department of General Surgery, Mayo Clinic, Jacksonville, USA

Editor Comment

This wonderful chapter, which may spark the interest of surgeons beyond the field of HPB surgery, is an account of the challenges faced by the pioneers of minimally invasive HPB surgery, challenges of a scientific but also a social nature. Some of these pioneers' careers took an unfavorable turn because of their dedication to innovation. We owe these legends and also their families gratitude, not only for their ingenuity and the inquisitiveness from which the patients of minimally invasive HPB surgeons benefit in the operating room every day but also for taking on the societal challenge and risks to their career in order to drive innovation. The chapter also explores the available data on the development of modern laparoscopic and robotic liver, biliary, and pancreas surgery from its beginnings of limited resection to the advanced minimally invasive surgery that is practiced at many centers around the world today.

Keywords: advanced minimally invasive HPB surgery, history of minimally invasive HPB surgery

All truth passes through three stages:

First it is ridiculed

Second it is violently opposed

Third it is accepted as self-evident

Arthur Schopenhauer

Hepatopancreatobiliary (HPB) operations are some of the most technically challenging procedures in surgery owing to the complex anatomy and proximity to vital structures. Over the years HPB procedures have excited, enthralled, and humbled surgeons all over the world. At the same time, the complexities of the disease processes have driven innovation not just in surgery but in medicine in general. The development of minimally invasive HPB surgery is synonymous with the development of laparoscopy and is perhaps the “holy grail” of laparoscopic surgery.

1.1 Beginnings

The term laparoscopy comes from “laparoskopie,” which is derived from two Greek words: laparo, meaning “flank,” and the verb skopos, meaning “to look or observe” [1]. The exploration of the human body through small or natural orifices dates back to the time of Hippocrates [2]. Hippocrates described the use of a primitive anoscope for the examination of hemorrhoids in 400 BC [2]. An Arab physician, Abulcasis, added a light source to the instrument for the exploration of the cervix in AD 1000 [2,3]. Many centuries later, in 1585, Giulio Cesare Aranzi inspected the nasal cavity by reflecting a beam of light through water [2].

In 1805 Phillipp Bozzini examined the urethra using an instrument that consisted of a wax candlelit chamber inside a tube which reflected light from a concave mirror [2,3]. Bozzini called it the “lichtleiter,” and it is considered the first real endoscope (Figure 1.1 and Figure 1.2) [2,3]. Using his lichtleiter, Bozzini managed to study the bladder directly, and his pioneering efforts laid the foundations of modern endoscopy.

Figure 1.1 Self-portrait of a young Bozzini (ca. 1805). Source: Frankfurt town archives.

Figure 1.2 The lichtleiter (an original owned by the American College of Surgeons, Bush Collection). The 200th Anniversary of the First Endoscope: Phillip Bozzini (1773–1809). Source: Morgenstern 2005 [4]. Reproduced with permission of Sage Publications.

Over the next century, Pierre Salomon Segalas and Antoine Jean Desormeaux from France refined Bozzini's lichtleiter and took the first steps in developing the modern cystoscope [2,3]. Desormeaux presented his idea to the Academy of Medicine in Paris, and for his efforts he is considered the “father of cystoscopy” [3]. Around the same time, over in the United States, John Fischer in Boston was using a similar instrument to perform vaginoscopies, and in Dublin, Ireland, Francis Cruise was performing endoscopies on the rectum [2].

In 1877 a urologist from Berlin, Maximilian Nitze, created what is considered the first modern endoscope using a platinum wire heated by electricity and encased in a metal tube (Figure 1.3 and Figure 1.4) [2,3]. A few years later, in 1880, Thomas Edison invented the light bulb, which revolutionized the way endoscopies were performed [3,6]. While these innovations all made advances in laparoscopy possible, little else occurred in the field until the beginning of the twentieth century.

Figure 1.3 Maxmilian Nitze. Source: https://de.wikipedia.org/wiki/Datei:Max_Nitze_Urologe.jpg#file. Used under CC BY-SA 3.0 - http://creativecommons.org/licenses/by-sa/3.0/legalcode.

Figure 1.4 Nitze cystoscope of 1877. Source: Mouton 1998 [5]. Reproduced with permission of Springer.

1.2 Advent of Laparoscopy

George Kelling from Germany is credited with exploring the abdominal cavity using a scope after creating pneumoperitoneum in 1901 (Figure 1.5). Kelling was a surgeon and first performed laparoscopies on dogs; he called the procedure “coelioskope” [2,3,6,7] (Box 1.1). The technique involved injecting the canine's abdomen with oxygen filtered through sterile cotton and then using Nitze's cystoscope to inspect the abdominal contents. Kelling performed this procedure in humans, but his findings were not published [3]. Around the same time, a Swedish internist called Hans Christian Jakobaeus popularized the procedure in humans by using a colposcope with a mirror to assess the abdomen of a pregnant woman [7]. In 1911 Jakobaeus presented his work Über Laparo- und Thorakoskopie and later continued his work in thoracoscopy (Figure 1.6) [3,6,7,8]. Jakobaeus used trocars very similar to the ones used today and is also credited with coining the term “laparoscopy” [3]. Not too far away in Petrograd (modern-day St Petersburg), Dimitri Ott performed the same procedure and called it “ventroscopy” [6,7]. The first to use the laparoscopic technique in the United States was Bertram M. Bernheim in 1911 [9]. Bernheim was a surgeon at the Johns Hopkins University, and he called this procedure “organoscopy” [2,3,6–8,11]. Bernheim, like many others at the time, had not heard of the work of Kelling and Jakobaeus.

Box 1.1 Different Terms Used Historically

Coelioscope: George Kelling, 1901 (Germany)

Ventroscopy: Dimitri Ott, 1901 (Petrograd/St Petersburg)

Organoscopy: Bertram Berheim, 1911 (Johns Hopkins University)

Figure 1.5 George Kelling. Source: https://en.wikipedia.org/wiki/Georg_Kelling#/media/File:Portrait_georg_kelling.jpg. Used under CC BY-SA 3.0 de - http://creativecommons.org/licenses/by-sa/3.0/de/deed.en.

Figure 1.6 Hans Christian Jakobaeus MD, performing a thoracoscopy. Source: Braimbridge 1993 [10]. Reproduced with permission of Elsevier.

Up to this point, all the procedures for exploring the abdominal cavity were performed with oxygen [3]. In 1924, Richard Zollikofer proposed that pneumoperitoneum be obtained using carbon dioxide. Carbon dioxide had two advantages: one was the rapid reabsorption of carbon dioxide by the peritoneal membrane and, unlike oxygen, it was noncombustible [3,6]. In 1929, Heinz Kalk, a German gastroenterologist, designed a new lens system with 135° vision and introduced the technique of “double trocar.” This invention eventually led to more refinements and the introduction of instruments into the cavities [2,3,6,7]. Between 1929 and 1959, Kalk submitted many articles on diagnostic laparoscopy; he is considered the “father of modern laparoscopy” [3].

The first therapeutic intervention was carried out by the German physician Fervers, who performed the lysis of abdominal adhesions and a liver biopsy [3,6]. Another significant advancement in laparoscopy is credited to the Hungarian physician Janos Veress. In 1938, he created a retractable needle to create pneumoperitoneum. We are all familiar with the Veress needle, but interestingly, it was initially used for the treatment of tuberculosis with pneumothorax in the preantibiotic era [2,3,6,7]. This technique was not accepted by all surgeons as it was considered unsafe. This led, in 1974, to Chicago-based gynecologist Harrith M. Hasson creating the open technique to access the abdominal cavity and achieve placement of the trocar that bears his name [2]. Raoul Palmer performed diagnostic laparoscopies in women and advised placing the patient in the Trendelenburg position for better visualization of the pelvis [2]. In addition, he was the first to control abdominal pressure during the procedure – two important aspects of modern laparoscopy [2].

In 1952, laparoscopic surgery underwent a revolution when French scientists M. Fourestier, A. Gladu, and J. Vulmiere created fiber-optics with cold light [3]. Two years later, scientists Lawrence Curtiss, Basil Hirschowitz, and Wilbur Peters did the same at the University of Michigan and brought cold light fiber-optics into practice in 1957. With improved visualization of the abdominal cavity, the advances in laparoscopy gained momentum [2].

Few surgeons have influenced the development of laparoscopic surgery more than the German gynecologist Kurt Semm. A pioneer in minimally invasive surgery, Semm developed a system of automatic insufflation in 1977. This consisted of a system of suction and irrigation, laparoscopic thermocoagulation, and the laparoscopic scissors as well as the “pelvitrainer” (Figure 1.7) used to teach laparoscopic techniques [2,3,6,7]. In 1981, Semm performed the first totally laparoscopic appendectomy [2,3,6,7]. The next significant milestone was the development of the high-resolution video camera in 1982 [2]. Since then the introduction of xenon/argon light sources and high-definition cameras has further improved visualization [2].

Figure 1.7 Kurt Semm's “pelvitrainer.” Surgical training system with a novel approach. Source: Semm 1986 [12]. Reproduced with permission of Thieme.

Despite the obvious potential advantages, skepticism regarding laparoscopic surgery remained prevalent because “big surgeons make big incisions” [3]. In 1985, the first totally laparoscopic cholecystectomy using the Veress needle for access and the trocar called the “galloscope” was carried out by German surgeon Erich Mühe (Figure 1.8) during a two-hour-long intervention [5,11]. Mühe encountered significant criticism, and this great achievement was initially unrecognized [11]. Subsequently, in 1987, Philippe Mouret, a French gynecologist, performed the first laparoscopic cholecystectomy in France [2,3,6,13].

Figure 1.8 Erich Mühe. Source: Society of Laparoendoscopic Surgeons.

Over the years, continued refinements in techniques and instrumentation have enabled surgeons to push the envelope even further. In a short span of less than three decades, minimally invasive surgery has grown exponentially. What seemed like virtual reality in 1987 is now the new norm, and the laparoscopic approach has become the standard of care for many abdominal surgical procedures (Box 1.2).

Box 1.2 Important Historical Events in Minimally Invasive HPB Surgery

1901: Kelling examines the abdominal cavity of the dog with a cystoscope

1911: Jakobaeus – first laparoscopic series in a human

1929: Kalk – oblique view, double trocar technique

1938: Veress – abdominal puncture needle

1970: Semm – automatic insufflation

1974: Hasson – open laparoscopy trocar

1986: TV camera adapted to optics

1987: First laparoscopic cholecystectomy by Mouret

1992: First laparoscopic liver resection by Gagner

1994: First laparoscopic pancreaticoduodenectomy by Gagner and Pomp

1.3 Laparoscopic Hepatopancreatobiliary (HPB) Surgery

1.3.1 Gallbladder Surgery