BOOK
Principles of Gynecologic Oncology Surgery E-Book
Pedro T Ramirez | Michael Frumovitz | Nadeem R Abu-Rustum
(2018)
Additional Information
Book Details
Abstract
With an emphasis on a practical, "how-to" approach, this comprehensive text addresses the most important and commonly performed procedures in gynecologic oncology surgery today. Written by leaders in the field, Principles of Gynecologic Oncology Surgery clearly describes the critical steps for each procedure, provides up-to-date information on the recent literature, and includes high-quality illustrations of anatomy and technique.
- Covers hot topics such as Enhanced Recovery After Surgery (ERAS), sentinel lymph node mapping, and minimally invasive surgery (robotic surgery, advanced laparoscopic surgery, and single site surgery).
- Includes expert coverage of reconstructive surgery, colorectal surgery, urology, and vascular surgery, each written by surgeon leaders in that particular field.
- Addresses the diagnosis, management and prevention of surgical complications.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| Principles of Gynecologic Oncology Surgery | i | ||
| Principles of Gynecologic Oncology Surgery | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Foreword | ix | ||
| Preface | x | ||
| Contents | xi | ||
| Video Contents | xiii | ||
| 1 - Anatomy and Principles of Surgery | 1 | ||
| 1 - Introduction to Principles of Gynecologic Oncology Surgery | 1 | ||
| 2 - Abdominal and Pelvic Anatomy | 3 | ||
| Pelvic Anatomy | 3 | ||
| Bony Pelvis | 3 | ||
| Ilium | 3 | ||
| Ischium | 3 | ||
| Pubis | 3 | ||
| Sacrum | 3 | ||
| Orientation of the Bony Pelvis | 3 | ||
| Anatomic Landmarks of the Bony Pelvis | 4 | ||
| Ischial Spine | 4 | ||
| Coccyx | 4 | ||
| Pubic Arch | 4 | ||
| Pectineal Line | 4 | ||
| Pelvic Ligaments | 4 | ||
| Sacrospinous Ligament | 4 | ||
| Sacrotuberous Ligament | 4 | ||
| Pelvic Muscles | 5 | ||
| Muscles of the Lateral Pelvis | 5 | ||
| Obturator Internus Muscle | 5 | ||
| Piriformis Muscle | 6 | ||
| Muscles of the Pelvic Floor | 6 | ||
| Levator Ani Muscle Complex | 6 | ||
| Arcus Tendineus Levator Ani | 6 | ||
| Puborectalis Muscle | 6 | ||
| Avascular Spaces | 6 | ||
| Retropubic Space (Space of Retzius) | 6 | ||
| Paravesical Spaces | 6 | ||
| Pararectal Space | 8 | ||
| Vesicovaginal Space | 8 | ||
| Rectovaginal Space | 8 | ||
| Presacral Space | 9 | ||
| Uterine Support Structures | 10 | ||
| Parametria | 10 | ||
| Round Ligaments | 10 | ||
| Broad Ligament | 10 | ||
| Pelvic Vasculature | 11 | ||
| Arterial Supply | 11 | ||
| Venous Drainage | 13 | ||
| Pelvic Lymphatic System | 13 | ||
| Pelvic Nerves (Fig. 2.30) | 15 | ||
| Somatic Nerves | 15 | ||
| Autonomic Nerves | 15 | ||
| Pelvic Viscera | 17 | ||
| Female Upper Genital Tract | 17 | ||
| Bladder | 19 | ||
| Ureters | 19 | ||
| Sigmoid Colon, Rectum, and Anus | 20 | ||
| Perineum | 20 | ||
| Perineal Membrane | 20 | ||
| Urogenital Triangle | 20 | ||
| Perineal Body | 20 | ||
| Anal Triangle | 21 | ||
| Ischiorectal Fossa | 21 | ||
| Vulva | 21 | ||
| Vagina | 21 | ||
| Urethra | 22 | ||
| The Retroperitoneum | 22 | ||
| Retroperitoneal Vasculature | 23 | ||
| Abdominal Aorta | 23 | ||
| Branches of the Abdominal Aorta | 23 | ||
| Inferior Vena Cava | 26 | ||
| Variations | 26 | ||
| Collateral Circulation | 26 | ||
| Lymphatic System | 28 | ||
| Retroperitoneal Nerves | 28 | ||
| Adrenal Glands | 29 | ||
| Arterial Supply | 30 | ||
| Venous Drainage | 30 | ||
| Lymphatic Drainage | 30 | ||
| Kidneys | 30 | ||
| Gerota Fascia | 30 | ||
| Anatomic Relations | 30 | ||
| Vascular Supply | 31 | ||
| Lymphatic Drainage | 31 | ||
| Ureters | 32 | ||
| Anatomy of the Upper Abdomen and Midabdomen | 32 | ||
| The Diaphragm | 32 | ||
| Diaphragmatic Attachments | 32 | ||
| Central Tendon of the Diaphragm | 33 | ||
| Diaphragmatic Apertures | 33 | ||
| Nerve Supply | 34 | ||
| Blood Supply | 34 | ||
| Lymphatic Drainage | 34 | ||
| The Stomach | 34 | ||
| Gastroesophageal Junction | 34 | ||
| Gastroduodenal Junction | 34 | ||
| Lesser Curvature | 34 | ||
| Greater Curvature | 35 | ||
| Anterosuperior Surface | 35 | ||
| Posteroinferior Surface | 35 | ||
| Segments of the Stomach | 35 | ||
| Lesser Omentum | 35 | ||
| Greater Omentum | 35 | ||
| Venous Drainage | 36 | ||
| Lymphatic Drainage | 37 | ||
| Nerves of the Stomach | 37 | ||
| Parasympathetic Nerve Supply | 37 | ||
| Sympathetic Nerve Supply | 37 | ||
| Duodenum and Pancreas | 37 | ||
| The Pancreas | 38 | ||
| Venous Drainage | 39 | ||
| Lymphatic Drainage | 40 | ||
| Nerves of the Duodenum and Pancreas | 40 | ||
| The Liver | 40 | ||
| Ligamentous Attachments | 40 | ||
| Perihepatic Organs | 41 | ||
| Hepatic Segmentation | 41 | ||
| Couinaud Classification | 42 | ||
| Hepatic Vasculature | 42 | ||
| Arterial Vasculature | 42 | ||
| Venous Vasculature | 43 | ||
| Lymphatic Drainage | 43 | ||
| Innervation | 43 | ||
| Intrahepatic Biliary Tree | 44 | ||
| Extrahepatic Biliary Tract | 44 | ||
| Cystic Duct | 44 | ||
| Gallbladder | 44 | ||
| Common Bile Duct | 44 | ||
| Hepatocystic Triangle and Triangle of Calot | 44 | ||
| Arterial Supply | 44 | ||
| Venous Drainage | 45 | ||
| Lymphatic Drainage | 45 | ||
| Spleen | 45 | ||
| Small Intestine | 45 | ||
| Blood Supply and Lymphatics of the Small Intestine | 45 | ||
| Large Bowel | 46 | ||
| Cecum and Appendix | 46 | ||
| Ascending Colon | 46 | ||
| Transverse Colon | 46 | ||
| Descending Colon | 46 | ||
| Sigmoid Colon | 47 | ||
| Rectum | 47 | ||
| Anal Canal | 47 | ||
| Blood Supply to the Large Bowel | 47 | ||
| Conclusion | 48 | ||
| Suggested Readings | 48 | ||
| 3 - Enhanced Recovery After Surgery in Gynecologic Oncology Surgery | 50 | ||
| ERAS in Gynecologic Oncology | 50 | ||
| Elements of ERAS Program and Guidelines | 52 | ||
| Preoperative Components | 52 | ||
| Preoperative Counseling | 52 | ||
| Preoperative Optimization | 52 | ||
| Preoperative Mechanical Bowel Preparation | 53 | ||
| Preoperative Fasting and Carbohydrate Loading | 54 | ||
| Preanesthetic Medication | 54 | ||
| Thromboembolism Prophylaxis | 54 | ||
| Antimicrobial Prophylaxis | 55 | ||
| Intraoperative Components | 55 | ||
| Short-Acting Anesthesia | 55 | ||
| Multimodal Opioid-Sparing Regimens | 55 | ||
| Maintenance of Normothermia | 55 | ||
| No Routine Nasogastric Intubation or Drainage of the Peritoneal Cavity | 55 | ||
| Avoidance of Salt and Water Overload | 56 | ||
| Minimally Invasive Procedures | 56 | ||
| Postoperative Components | 56 | ||
| Postoperative Nausea and Vomiting Prophylaxis | 56 | ||
| Multimodal Analgesia | 56 | ||
| Avoidance of Salt and Water Overload | 57 | ||
| Early Oral Nutrition | 57 | ||
| Removal of Urinary Catheter | 57 | ||
| Early Mobilization | 57 | ||
| Postoperative Glucose Control | 57 | ||
| Audit of Compliance and Outcomes | 58 | ||
| Summary | 58 | ||
| References | 58 | ||
| 2 - Vulvar Cancer | 63 | ||
| 4 - Vulvar Surgery and Sentinel Node Mapping for Vulvar Cancer | 63 | ||
| Presentation, Diagnosis, and Workup | 65 | ||
| Presentation | 65 | ||
| Diagnosis | 65 | ||
| Preoperative Workup | 65 | ||
| Preoperative Considerations | 65 | ||
| Anatomy | 65 | ||
| Primary Surgical Treatment Versus Primary Radiation | 67 | ||
| Surgical Planning for Resection of Primary Tumor | 67 | ||
| Surgical Planning for Inguinofemoral Lymph Nodes | 67 | ||
| Sentinel Nodes in Vulvar Cancer | 69 | ||
| Surgical Procedures | 70 | ||
| Wide Local Excision | 70 | ||
| Wide Radical Excision | 71 | ||
| Complete Inguinofemoral Lymphadenectomy | 71 | ||
| Lymphatic Mapping and Sentinel Lymph Node Biopsy | 72 | ||
| Mapping Substances | 72 | ||
| Surgical Technique | 73 | ||
| Complications and Morbidity | 74 | ||
| References | 74 | ||
| 3 - Cervical Cancer | 77 | ||
| 5 - Conservative Surgery in Early-Stage Cervical Cancer | 77 | ||
| Radical Trachelectomy | 77 | ||
| Indications | 77 | ||
| Preoperative Evaluation | 78 | ||
| Surgical Approaches | 78 | ||
| Vaginal Radical Trachelectomy | 79 | ||
| Abdominal Radical Trachelectomy | 79 | ||
| Minimally Invasive Radical Trachelectomy | 79 | ||
| Intraoperative Schema | 80 | ||
| Pelvic Lymphadenectomy and Lymphatic Mapping | 80 | ||
| Obstetric Outcomes | 80 | ||
| Cervical Conization or Simple Hysterectomy in Low-Risk Patients | 81 | ||
| Rationale for Conservative Management of Cervical Cancer | 81 | ||
| Summary of Data From Retrospective Studies of Conservative Management | 81 | ||
| Prospective Trials of Conservative Surgical Management of Low-Risk Cervical Cancer | 81 | ||
| Conservative Surgery in Larger Cervical Tumors | 82 | ||
| Surgical Techniques | 82 | ||
| Abdominal (Robotic) Radical Trachelectomy | 82 | ||
| Step 1: Exploration of the Abdomen | 83 | ||
| Step 2: Exposure of the Retroperitoneum and Pelvic Spaces | 83 | ||
| Step 3: Uterine Artery Ligation and Ureteral and Parametrial Dissection | 83 | ||
| Step 4: Colpotomy and Cervical-Parametrial Amputation | 84 | ||
| Step 5: Placement of Uterine Cannula and Cerclage | 85 | ||
| Areas of Controversy | 85 | ||
| Complications of Radical Trachelectomy | 87 | ||
| Intraoperative Complications | 87 | ||
| Amenorrhea | 87 | ||
| Cerclage Erosion | 87 | ||
| Reoperation | 87 | ||
| Conversion to Radical Hysterectomy | 88 | ||
| Key Points | 88 | ||
| References | 88 | ||
| 6 - The Application of Sentinel Lymph Node Biopsy in Cervical Cancer* | 90 | ||
| Lymph Node Involvement in Cervical Cancer | 90 | ||
| Cervical Cancer: A Candidate for Sentinel Lymph Node Mapping | 91 | ||
| Anatomy of the Cervix and Its Lymphatic Channels | 91 | ||
| Efficiency of Sentinel Lymph Node Technique | 91 | ||
| Methodologies | 93 | ||
| Radioactive Tracers, Lymphoscintigraphy, and SPECT-CT | 93 | ||
| Lymphoscintigraphy Versus SPECT-CT | 94 | ||
| Colorimetric Dye | 94 | ||
| Fluorescence | 94 | ||
| The Performance of the Detection Modalities | 96 | ||
| Impact of Size of Metastasis in the Sentinel Node | 96 | ||
| Morbidity | 97 | ||
| Typical and Unexpected Locations of Sentinel Lymph Nodes | 97 | ||
| Limitations of Sentinel Lymph Node Technique | 98 | ||
| Indications for Sentinel Lymph Node Detection | 98 | ||
| Impact of Neoadjuvant Chemotherapy on Sentinel Lymph Node Detection | 99 | ||
| Technical Application and Suggested Algorithm | 100 | ||
| Conclusion | 100 | ||
| References | 100 | ||
| 7 - Abdominal Radical Hysterectomy | 104 | ||
| History of Radical Hysterectomy | 104 | ||
| Classification of Radical Hysterectomy | 104 | ||
| Type A Radical Hysterectomy | 104 | ||
| Type B Radical Hysterectomy | 104 | ||
| Type C Radical Hysterectomy | 105 | ||
| Lateral Parametria—Transverse (Horizontal) Resection Margins | 105 | ||
| Longitudinal (Deep Parametrial or Vertical) Resection Margins | 105 | ||
| Ventral Parametria—Transverse Resection Margins | 105 | ||
| 4 - Endometrial Cancer | 127 | ||
| 9 - Hysterectomy With Pelvic and Paraaortic Lymphadenectomy | 127 | ||
| Role of Lymphadenectomy | 127 | ||
| Therapeutic Value of Lymphadenectomy | 128 | ||
| Sentinel Nodes in Endometrial Cancer | 128 | ||
| Indications for Lymphadenectomy | 129 | ||
| Complications of Pelvic and Paraaortic Lymphadenectomy | 130 | ||
| Vascular Anatomic Variations in the Paraaortic Area | 132 | ||
| Tips and Tricks to Avoid Vascular Injuries During Lymphadenectomy | 132 | ||
| Role of Oophorectomy at the Time of Hysterectomy | 132 | ||
| Preoperative Evaluation | 133 | ||
| Perioperative Management | 133 | ||
| Surgical Technique | 133 | ||
| Hysterectomy | 133 | ||
| Open Abdominal Approach | 133 | ||
| Step 1: Exploration of the Abdomen | 133 | ||
| Step 2: Exposure of the Retroperitoneal Spaces and Ureteral Identification | 133 | ||
| Step 3: Adnexal Removal or Sparing | 134 | ||
| Step 4: Development of the Vesicouterine Fold and Caudal Reflection of the Bladder | 134 | ||
| Step 5: Division of the Cardinal and Uterosacral Ligaments | 134 | ||
| Step 6: Colpotomy and Vaginal Closure | 135 | ||
| Landmarks for Pelvic and Paraaortic Lymphadenectomy | 135 | ||
| Pelvic Lymphadenectomy | 135 | ||
| Paraaortic Lymphadenectomy | 135 | ||
| Lymphadenectomy: Pelvic Phase | 135 | ||
| Access to the Retroperitoneum | 135 | ||
| Lymph Node Dissection | 135 | ||
| Lymphadenectomy: Paraaortic Phase | 135 | ||
| Left Paraaortic Lymph Node Removal | 135 | ||
| Summary | 136 | ||
| Key Points | 138 | ||
| References | 139 | ||
| 10 - Sentinel Lymph Node Mapping for Endometrial Cancer | 141 | ||
| Importance of Lymph Node Assessment | 141 | ||
| Sentinel Lymph Node Mapping Techniques | 143 | ||
| Colored Dye Injection | 143 | ||
| Sentinel Lymph Node Mapping Algorithm | 144 | ||
| Sentinel Lymph Node Ultrastaging | 145 | ||
| Summary | 147 | ||
| References | 147 | ||
| 5 - Ovarian Cancer | 149 | ||
| 11 - Indications for Laparoscopic Assessment of Cytoreduction | 149 | ||
| Background | 149 | ||
| Imaging Tools for Preoperative Evaluation | 149 | ||
| Serum Biomarkers | 149 | ||
| Preoperative Imaging Modalities | 149 | ||
| Combination Predictive Models | 150 | ||
| Rationale for Laparoscopic Evaluation | 150 | ||
| History of Laparoscopy to Assess Feasibility of Cytoreduction | 151 | ||
| Indications for Laparoscopic Evaluation | 152 | ||
| Method of Laparoscopic Assessment | 152 | ||
| Parietal Peritoneum | 152 | ||
| Diaphragmatic Disease | 152 | ||
| Omentum | 152 | ||
| Bowel Infiltration | 153 | ||
| Stomach, Spleen, and Lesser Omentum | 153 | ||
| Liver Metastases | 153 | ||
| Technique for Laparoscopic Assessment | 153 | ||
| Incomplete Evaluation | 155 | ||
| Clinical Implications | 155 | ||
| Laparoscopic Evaluation at Interval Cytoreductive Surgery | 155 | ||
| Prospective Trial Results | 156 | ||
| Summary | 156 | ||
| References | 156 | ||
| 12 - Radical Upper Abdominal Surgery: Liver, Diaphragm, and Spleen | 158 | ||
| Anatomic Considerations | 158 | ||
| Liver | 158 | ||
| Liver Surface | 160 | ||
| Liver Segments | 160 | ||
| Porta Hepatis | 160 | ||
| Hepatic Veins | 161 | ||
| Diaphragm | 161 | ||
| Muscular Components | 161 | ||
| Apertures and Visceral Relations | 161 | ||
| Innervation and Vascular Supply | 162 | ||
| Ligaments of the Liver and the Bare Area | 162 | ||
| Spleen | 162 | ||
| Pancreas | 163 | ||
| Cytoreductive Surgery | 163 | ||
| Mobilization and Exposure | 163 | ||
| Surface Liver Disease | 163 | ||
| Parenchymal Liver Disease | 163 | ||
| Nonanatomic Wedge Resection | 164 | ||
| Total Inflow Occlusion | 164 | ||
| Major and Minor Hepatic Resections | 165 | ||
| Microwave Ablation | 165 | ||
| Cryoablation | 166 | ||
| Porta Hepatis Disease | 166 | ||
| Cytoreduction of Diaphragmatic Disease | 166 | ||
| Exposure | 166 | ||
| Liver Mobilization | 166 | ||
| Diaphragm Peritonectomy | 167 | ||
| Full-Thickness Diaphragm Resection | 167 | ||
| Spleen | 168 | ||
| Exposure | 168 | ||
| Splenectomy | 168 | ||
| Posterior Approach | 168 | ||
| Anterior Approach | 169 | ||
| Laparoscopic Splenectomy | 169 | ||
| Splenic Injury | 169 | ||
| Distal Pancreatectomy | 169 | ||
| Radical en Bloc Left Upper Quadrant Resection | 169 | ||
| Conclusion | 170 | ||
| References | 170 | ||
| 13 - Radical Pelvic and Retroperitoneal Ovarian Cancer Surgery | 172 | ||
| Pelvis | 172 | ||
| Retroperitoneum | 172 | ||
| Retroperitoneal Node Dissection | 173 | ||
| Pelvic Lymphadenectomy: Surgical Technique | 173 | ||
| Step 1: Dissection of the Avascular Spaces of the Pelvis | 173 | ||
| Step 2: Separation of the Nodal Tissue From the Iliac Vessels | 175 | ||
| Step 3: Removal of the Common Iliac Nodes | 175 | ||
| Aortic Node Dissection | 175 | ||
| Anatomic Considerations | 175 | ||
| Transperitoneal Technique by Laparotomy | 175 | ||
| Step 1: Peritoneal Incision and Exposure of the Area of Dissection | 175 | ||
| Step 2: Removal of the Paracaval Nodes | 176 | ||
| Step 3: Removal of the Paraaortic Nodes | 177 | ||
| Step 4: Removal of the Node Specimen Between the Aorta and the Vena Cava | 178 | ||
| Pelvic Surgery for Advanced Ovarian Cancer: Surgical Technique | 178 | ||
| Surgical Technique | 178 | ||
| Type I Radical Oophorectomy | 179 | ||
| Type II Radical Oophorectomy | 179 | ||
| Bowel Anastomosis | 180 | ||
| Type III Radical Oophorectomy | 180 | ||
| References | 181 | ||
| 14 - Complications and Management of Radical Cytoreduction | 182 | ||
| Complication Classification Systems | 182 | ||
| Preoperative Risk Assessment for Complications | 183 | ||
| Surgical Complexity Scores | 184 | ||
| Surgical Procedures as Predictors of Perioperative Complications | 184 | ||
| Selection of Patients for Surgery | 185 | ||
| Preoperative Care Planning and Prevention of Complications | 185 | ||
| Thromboembolic Prophylaxis | 185 | ||
| Nutritional Support | 185 | ||
| Smoking and Alcohol Cessation | 185 | ||
| Preoperative Antibiotics | 185 | ||
| Postoperative Care Planning | 185 | ||
| Intensive Care Unit Hospitalization | 185 | ||
| Glycemic Control | 185 | ||
| Fluid Management | 185 | ||
| Maintenance of Electrolyte Homeostasis | 185 | ||
| Nutritional Support | 186 | ||
| Correction of Anemia | 186 | ||
| Pain Management | 186 | ||
| Respiratory Management | 186 | ||
| Postoperative Thromboembolism Prophylaxis | 186 | ||
| Ambulation and Discharge | 186 | ||
| Perioperative Complications | 186 | ||
| Hemorrhage | 187 | ||
| Infection | 187 | ||
| Surgical Site Infection | 187 | ||
| Digestive Tract Fistula | 187 | ||
| Other Infectious Complications | 188 | ||
| Gastrointestinal Tract Complications | 188 | ||
| Gastric Distention | 188 | ||
| Ileus | 188 | ||
| Ascites Reaccumulation and Abdominal Compartment Syndrome | 188 | ||
| Hematologic Disorders | 188 | ||
| Thromboembolic Complications | 188 | ||
| Respiratory Complications | 189 | ||
| Pulmonary Infection | 189 | ||
| Pleural Effusion | 189 | ||
| Other Respiratory Complications | 189 | ||
| Cardiac and Neurovascular Complications | 189 | ||
| Renal Failure | 189 | ||
| Mortality | 190 | ||
| Conclusion | 190 | ||
| References | 190 | ||
| 6 - Pelvic Exenteration | 193 | ||
| 15 - Pelvic Exenteration for Gynecologic Cancers | 193 | ||
| History | 193 | ||
| Indications | 194 | ||
| Classification | 194 | ||
| Preoperative Imaging | 195 | ||
| Prognostic Factors and Contraindications | 197 | ||
| Prognostic Factors | 197 | ||
| Surgical Margins | 198 | ||
| Histologic Type | 198 | ||
| Lymph Node Status | 198 | ||
| Time to Recurrence | 198 | ||
| Other Factors | 198 | ||
| Contraindications | 198 | ||
| Surgical Technique | 199 | ||
| Development of Pelvic Spaces | 199 | ||
| Ureteral Dissection | 199 | ||
| Ligament (Parametria) Detachment | 199 | ||
| Endopelvic Fascia and Levator Ani Muscle Resection | 199 | ||
| Vaginectomy | 199 | ||
| Perineal Resection | 199 | ||
| Oncologic Outcomes | 200 | ||
| Combined Treatment | 200 | ||
| Intraoperative Radiotherapy | 200 | ||
| Preoperative Chemotherapy | 200 | ||
| Extension of Radicality | 200 | ||
| Lateral Pelvic Side Wall Excision | 201 | ||
| Resection of Large Vessels, Nerves, and Bones | 201 | ||
| Resection of External Iliac or Common Iliac Vessels | 202 | ||
| Large Pelvic Nerve Resection | 202 | ||
| Composite Exenteration | 202 | ||
| Counseling | 204 | ||
| References | 204 | ||
| 16 - Complications of Pelvic Exenteration | 207 | ||
| Medical Complications | 207 | ||
| Febrile Morbidity | 207 | ||
| Thromboembolic Events | 208 | ||
| Incidence and Guidelines | 208 | ||
| Signs and Symptoms | 208 | ||
| Evaluation of Thromboembolic Events | 208 | ||
| Treatment of Thromboembolic Events | 209 | ||
| Acute Renal Events | 209 | ||
| Initial Evaluation After Diagnosis | 209 | ||
| Patient Evaluation | 209 | ||
| Urinalysis | 210 | ||
| Urine Sodium Excretion | 210 | ||
| Urine Volume | 210 | ||
| Volume Depletion | 210 | ||
| Volume Overload | 210 | ||
| Hyperkalemia | 210 | ||
| Prognosis | 210 | ||
| Surgical Complications | 211 | ||
| Dehiscence and Evisceration | 211 | ||
| Necrotizing Fasciitis | 211 | ||
| Urinary Diversion Complications | 212 | ||
| Bowel-Related Complications | 212 | ||
| Postoperative Ileus | 212 | ||
| Bowel Obstruction | 214 | ||
| Signs and Symptoms | 214 | ||
| Diagnosis | 214 | ||
| Treatment | 215 | ||
| Anastomotic Leaks | 216 | ||
| Management | 217 | ||
| Stomal Complications | 218 | ||
| Skin Irritation | 218 | ||
| Retraction | 219 | ||
| Prolapse | 220 | ||
| Parastomal Hernia | 220 | ||
| Necrosis | 221 | ||
| Mucocutaneous Separation | 222 | ||
| Fistulas | 222 | ||
| Signs and Symptoms | 222 | ||
| Evaluation | 222 | ||
| Treatment | 222 | ||
| Pelvic Reconstruction Complications | 223 | ||
| Modified Rectus Abdominis Flap | 223 | ||
| Gracilis Myocutaneous Flap | 224 | ||
| References | 224 | ||
| 7 - Surgery on the Intestinal Tract227 | 227 | ||
| 17 - Small Bowel and Large Bowel Resection and Anastomosis | 227 | ||
| Regional Vascular Anatomy of the Small Bowel and Large Bowel | 227 | ||
| Anatomy of the Small Intestine | 231 | ||
| Anatomy of the Large Intestine | 233 | ||
| Surgical Techniques | 234 | ||
| General Principles of Intestinal Surgery | 234 | ||
| Intestinal Anastomosis | 235 | ||
| Techniques of Bowel Anastomosis | 235 | ||
| Hand-Sewn Anastomoses | 235 | ||
| Stapled Anastomosis | 236 | ||
| Types of Bowel Anastomoses | 236 | ||
| End-to-End Anastomosis | 236 | ||
| End-to-Side Anastomosis | 238 | ||
| Side-to-Side Functional End-to-End Anastomosis | 238 | ||
| Small Bowel Resection | 238 | ||
| Ileocecal Resection | 240 | ||
| Transverse Colectomy | 241 | ||
| Right Hemicolectomy in Conjunction With Omental Disease | 241 | ||
| Left Hemicolectomy in Conjunction With Omental Disease | 241 | ||
| Rectal Resection | 241 | ||
| References | 244 | ||
| 18 - Management of Bowel Surgery Complications | 245 | ||
| Special Anatomy | 245 | ||
| Splenic Flexure | 245 | ||
| Ureteric Injury | 245 | ||
| Vascular Anatomy | 246 | ||
| Vascular Hemorrhage | 246 | ||
| Iatrogenic Injuries During Minimally Invasive Surgery | 248 | ||
| Deep Space Surgical Site Infections | 250 | ||
| Anastomotic Complications | 251 | ||
| Acute Complications | 252 | ||
| Enterocutaneous Fistulas | 253 | ||
| Blind Loop Syndrome and Intestinal Bacterial Overgrowth | 254 | ||
| Postsurgical Nutritional Deficiencies and Short Gut Syndrome | 254 | ||
| Obstructions | 254 | ||
| References | 256 | ||
| 8 - Surgery on the Urinary Tract | 259 | ||
| 19 - Management of Urologic Complications in Gynecologic Oncology Surgery | 259 | ||
| Ureteral Injuries and Management | 259 | ||
| Primary Ureteral Repair | 262 | ||
| Ureteroneocystostomy | 263 | ||
| Advanced Reconstructive Procedures | 266 | ||
| Bladder Injuries and Management | 267 | ||
| Fistula Complications | 267 | ||
| Neurogenic Bladder | 268 | ||
| Conclusion | 270 | ||
| References | 270 | ||
| 9 - Pelvic Reconstructive Procedures273 | 273 | ||
| 20 - Pelvic Reconstruction in Gynecologic Oncology Surgery | 273 | ||
| Indications | 273 | ||
| Preoperative Evaluation and Patient Selection | 273 | ||
| Procedures | 273 | ||
| Secondary Intention and Complex Primary Closure | 273 | ||
| Procedure Details | 273 | ||
| Skin Grafting and Skin Substitutes | 273 | ||
| 10 - Minimally Invasive Surgery331 | 331 | ||
| 24 - Laparoendoscopic Single-Site Surgery in Gynecologic Oncology | 331 | ||
| Potential Benefits of Laparoendoscopic Single-Site Surgery | 332 | ||
| Postoperative Pain | 332 | ||
| Incisional Morbidity | 333 | ||
| Cosmesis | 333 | ||
| Incisional Utility | 334 | ||
| Challenges of Laparoendoscopic Single-Site Surgery | 334 | ||
| Maintenance of Pneumoperitoneum | 334 | ||
| Prevention of Hand Collision | 335 | ||
| Triangulation | 336 | ||
| Perspective in Field of View | 336 | ||
| Learning Curve | 336 | ||
| Patient Selection | 337 | ||
| Orientation to Equipment | 337 | ||
| Instrument, Hand, and Body Position | 337 | ||
| Robotic-Assisted Laparoendoscopic Single-Site Surgery | 337 | ||
| Procedures in Detail | 338 | ||
| Laparoendoscopic Single-Site Surgery Adnexectomy | 338 | ||
| Laparoendoscopic Single-Site Surgery Hysterectomy | 339 | ||
| Laparoendoscopic Single-Site Surgery Staging Lymphadenectomy | 340 | ||
| Pelvic Node Dissection | 340 | ||
| Paraaortic Node Dissection | 341 | ||
| Robotic-Assisted Laparoendoscopic Single-Site Hysterectomy and Bilateral Salpingo-oophorectomy | 341 | ||
| Conclusion | 342 | ||
| Conflicts of Interest | 342 | ||
| Acknowledgment | 342 | ||
| References | 342 | ||
| 25 - Laparoscopic Approach to Gynecologic Malignancy | 344 | ||
| Patient Selection for Laparoscopic Surgery | 345 | ||
| Preoperative Evaluation | 345 | ||
| Tumor Manipulation, Tissue Extraction, and Port-Site Metastasis | 346 | ||
| Patient and Operating Room Setup | 346 | ||
| Trocar Placement | 347 | ||
| ?Abdominal Exploration (Video 25.1) | 348 | ||
| ?Total Laparoscopic Hysterectomy (Video 25.2) | 348 | ||
| Exposure of the Retroperitoneum | 348 | ||
| Salpingectomy and/or Adnexectomy | 348 | ||
| Posterior Leaf and Uterosacral Ligament Section | 348 | ||
| Vesicouterine Space Dissection | 348 | ||
| Transection of Uterine Vessels | 349 | ||
| Colpotomy and Uterine Extraction | 349 | ||
| Vaginal Cuff Suture | 349 | ||
| Laparoscopic Radical Hysterectomy | 349 | ||
| Laparoscopic Type A Radical Hysterectomy (Extrafascial Hysterectomy) | 349 | ||
| ?Laparoscopic Type B Radical Hysterectomy (Video 25.3) | 350 | ||
| Pelvic Lymphadenectomy | 350 | ||
| Posterior Leaf of the Broad Ligament, Uterosacral Ligament, and Rectovaginal Space Dissection | 351 | ||
| Mobilization of the Bladder | 351 | ||
| Ureteral Tunnel Dissection | 351 | ||
| Uterine Pedicle Section and Paracervical Tissue Dissection | 352 | ||
| Colpotomy and Uterine Extraction | 352 | ||
| Ovarian Transposition (Oophoropexy) | 352 | ||
| ?Laparoscopic Type C Radical Hysterectomy (Video 25.4) | 353 | ||
| Uterine Pedicle Section and Paracervical Tissue Dissection | 353 | ||
| Surgery Completion Survey | 353 | ||
| Postoperative Care After Laparoscopic Radical Hysterectomy | 353 | ||
| ?Laparoscopic Radical Trachelectomy (Video 25.5) | 354 | ||
| Technique of Laparoscopic Radical Trachelectomy | 355 | ||
| Vesicovaginal Space Dissection, Rectovaginal Space Dissection, and Uterosacral Resection | 355 | ||
| Uterine Artery Ligation and Paracervical Resection | 355 | ||
| Colpotomy | 356 | ||
| Cervical Transection and Margin Evaluation | 356 | ||
| Cervical Cerclage and Uterine Repositioning | 356 | ||
| ?Laparoscopic Pelvic Lymphadenectomy (Video 25.6) | 356 | ||
| Technique | 356 | ||
| Lateral Identification of the Obturator Nerve and Dissection of the Lumbosacral Lymph Nodes | 357 | ||
| Detaching the Lymph Nodes from the Iliac Vessels | 357 | ||
| Lymphadenectomy of the Obturator Fossa | 357 | ||
| Retroperitoneal Exposure | 358 | ||
| Paracaval Dissection and Ovarian Vessel Resection | 359 | ||
| Presacral and Intercavoaortic Dissection | 359 | ||
| Paraaortic Inframesenteric Dissection | 359 | ||
| Paraaortic Supramesenteric Dissection | 359 | ||
| Laparoscopic Surgery for Ovarian Neoplasms | 360 | ||
| ?Adnexectomy for Suspected Ovarian Cysts (Video 25.8) | 360 | ||
| Technique | 360 | ||
| Adnexectomy | 360 | ||
| Cyst Extraction | 360 | ||
| Placement of Endobags in the Surgical Field | 361 | ||
| ?Laparoscopic Omentectomy and Peritoneal Biopsies (Video 25.9) | 361 | ||
| Omentectomy: Standard Technique | 361 | ||
| Omentectomy: Reverse Technique | 361 | ||
| Key Points | 361 | ||
| References | 362 | ||
| 26 - Robotic Surgery | 364 | ||
| Perioperative and Oncologic Outcomes in MinimallyInvasive Surgery | 364 | ||
| Advantages and Disadvantages of Robotic Surgery | 365 | ||
| Preoperative Evaluation | 366 | ||
| Perioperative Management—Enhanced Recovery Pathways | 366 | ||
| Surgical Techniques—Pelvic Procedures | 366 | ||
| Indications | 366 | ||
| Surgical Technique | 368 | ||
| Step 1: Room Setup | 368 | ||
| Step 2: Patient Positioning | 368 | ||
| Step 3: Sentinel Lymph Node Dye Injection | 369 | ||
| Step 4: Placement of a Uterine Manipulator | 369 | ||
| Step 5: Abdominal Entry | 369 | ||
| Step 6: Trocar Placement | 369 | ||
| Step 7: Examination of the Upper Abdomen | 370 | ||
| Step 8: Docking | 370 | ||
| Step 9: Instrument Selection | 370 | ||
| Step 10: Procedure | 371 | ||
| Step 11: Specimen Removal | 372 | ||
| Step 12: Vaginal Cuff Closure or Cerclage Placement—Instrument Selection | 372 | ||
| Step 13: Removing the Trocars | 372 | ||
| Step 14: Abdominal Incision Closure | 372 | ||
| Surgical Techniques—Upper Abdominal Procedures | 372 | ||
| Indications | 372 | ||
| Surgical Technique | 373 | ||
| Step 1: Room Setup | 373 | ||
| Step 2: Patient Positioning | 373 | ||
| Step 3: Abdominal Entry | 374 | ||
| Step 4: Trocar Placement | 374 | ||
| Step 5: Docking | 374 | ||
| Step 6: Instrument Selection | 374 | ||
| Step 7: Procedure | 374 | ||
| Step 8: Specimen Removal | 374 | ||
| Steps 9 and 10: Trocar Removal and Abdominal Incisional Closure | 374 | ||
| Surgical Techniques—Multiquadrant Procedures | 374 | ||
| Trocar Placement | 374 | ||
| Docking | 375 | ||
| Special Considerations | 375 | ||
| Pelvic Exenteration | 375 | ||
| Obesity and Robotic Surgery | 376 | ||
| Cost of Robotic Surgery in Gynecologic Oncology | 377 | ||
| Conclusion | 377 | ||
| References | 377 | ||
| 27 - Complications of Minimally Invasive Surgery | 381 | ||
| Complications During Abdominal Entry | 381 | ||
| Vascular Injuries at Abdominal Entry | 381 | ||
| Bowel Injuries at Abdominal Entry | 382 | ||
| Laparoscopic Bowel and Urinary Tract Injuries | 382 | ||
| Mechanism of Thermal Injuries | 382 | ||
| Preventing Gastrointestinal Tract Injuries | 382 | ||
| Laparoscopic Repair of Gastrointestinal Tract Injuries | 382 | ||
| Preventing Urinary Tract Injuries | 383 | ||
| Detection of Urinary Tract Injuries | 383 | ||
| Laparoscopic Repair of Urinary Tract Injuries | 383 | ||
| Subcutaneous Emphysema | 383 | ||
| Gas Embolism | 384 | ||
| Port-Site Hernias | 384 | ||
| Port-Site Metastasis | 386 | ||
| Vaginal Evisceration | 387 | ||
| Conclusion | 388 | ||
| Key Points | 388 | ||
| References | 389 | ||
| Index | 391 | ||
| A | 391 | ||
| B | 391 | ||
| C | 392 | ||
| D | 392 | ||
| E | 393 | ||
| F | 393 | ||
| G | 394 | ||
| H | 394 | ||
| I | 394 | ||
| J | 395 | ||
| K | 395 | ||
| L | 395 | ||
| M | 396 | ||
| N | 396 | ||
| O | 397 | ||
| P | 397 | ||
| Q | 399 | ||
| R | 399 | ||
| S | 400 | ||
| T | 401 | ||
| U | 401 | ||
| V | 402 | ||
| W | 402 | ||
| Z | 402 | ||
| IBC | ES2 |