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Laparoscopic Conventional Abdominoperineal (CAPE) and Extra-Levator Abdominoperineal Resection (ELAPE)
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Deepak Govil
The majority of shortcomings of the Lloyd-Davies position is related to the limited vision of the surgical site, which leads the dissection to be mostly blind and blunt, and does not follow the principle of the tumor-free technique. The prone jackknife position enables a sharp, standardized, and direct vision resection of the rectal stump, which ensures en bloc excision of the primary tumor, lesser CRM positivity, and lower perforation rates [15,16]. Since the levator ani muscles have been resectioned by laparoscopic, the perineal phase in the prone jackknife position becomes easy; also, this modified technique reduces blood loss and operative time, and the benefits are oncologically equivalent to the ELAPE.
Management of Toxic Colitis
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Sean T. Martin, Ravi Pokala Kiran
Many data now exist to support the routine use of minimally invasive techniques, with evidence to support reduced blood loss, fewer infective complications, a shorter length of stay and lower readmission rate.27–29 The authors favour conventional, multi-port laparoscopy. Briefly, under general anaesthesia, the patient is placed in the Lloyd–Davies position on the operating table. Using the Hasson technique, an optical access trocar is placed at the umbilicus. After establishing pneumoperitoneum, 3 × 5 mm trocars are placed – two on the right side (right upper and lower quadrants) and one in the left lower quadrant, or one each on the right, left and midline suprapubic locations. When feasible, the pre-marked ileostomy site may be used for port placement. A retrograde anticlockwise approach or instead an antegrade clockwise approach may be adopted.
Construction of an electrically stimulated gracilis neoanal sphincter
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Norman S Williams, Christopher LH Chan
The patient is placed in the modified Lloyd-Davies position (as described in Chapter 1.3, Safety and positioning in the operating room). The skinof the perineum, groin, and inner aspect of the thigh on the side chosen for mobilization of the gracilis is prepared with povidone-iodine. If the covering stoma is to be eventually sited on the right side of the patient’s abdomen, the left gracilis muscle is chosen for mobilization.
The use of the V-Care laparoscopic uterine manipulator to facilitate total abdominal hysterectomy: a novel approach and case-series
Published in Journal of Obstetrics and Gynaecology, 2020
Mohamed S. Allam, Khaled El-Sapagh, Marwa M. Allam, Evelyn J. Ferguson, Mohamed K. Mehasseb
All patients underwent a standard preoperative preparation. The patient was placed in a modified Lloyd-Davies position at approximately a 30 to 45 degrees angle. A Foley catheter was placed into the bladder. A suitably sized V-Care (ConMed) uterine manipulator was selected, inserted and fixed in place after pelvic examination and assessment. The V-Care uterine manipulator/elevator is intended for use in laparoscopic hysterectomy, with a specially designed double-cup system. The cervical (forward, green) cup displaces the ureters, retracts the urinary bladder, pushes the posterior fornix incision line well above the Douglas pouch and the uterus away from the bottom of the pelvis/pelvic side walls, and defines the colpotomy incision. A second vaginal (back, blue) cup supports the green cup, prevents loss of laparoscopic pneumoperitoneum during colpotomy and displaces the sigmoid colon away from the uterus. The manipulator tube and handle conform to the shape of the pelvic curve and allows for easy manipulation of the uterus. The V-Care manipulator’s tube is inserted into the cervix so that the forward balloon is in the uterine cavity. A 10 mls inflatable balloon at the distal end is used to retain the manipulator tube within the uterine cavity. After insertion, the cervical cup is pushed so that it encompasses the cervix. With the vaginal fornices against the cervical cup, the vaginal cup is then placed into position and locked in place. Properly inserted, the V-Care handle rests at a level above the patient’s thighs, where it is conveniently accessible for uterine manipulation. The handle is designed to be grasped and held by the assistant surgeon or the nurse with ease, and as such, no additional personnel is required.
Salvage open radical prostatectomy for recurrent prostate cancer following MRI-guided transurethral ultrasound ablation (TULSA) of the prostate: feasibility and efficacy
Published in Scandinavian Journal of Urology, 2020
Shiva Madhwan Nair, Noah Stern, Malcolm Dewar, Khurram Siddiqui, Elliot Smith, Jose A. Gomez, Madeleine Moussa, Joseph L. Chin
Salvage surgery was performed with modifications to the open retropubic radical prostatectomy technique with the retrograde Campbell approach as described previously [6]. The open approach was opted over the robotic approach to allow easy intraoperative access to the perineum and rectum, and because of the uncertainty of the degree of operative difficulty. Patients were placed in a modified Lloyd-Davies position with the table flexed at 15 degrees just below the waist. Bilateral pelvic lymphadenectomy was performed. Special attention was paid to the posterior dissection with an assistant placing a finger in the rectum to help provide tactile feedback in proximity to the rectum.