OBES SURG DOI 10.1007/s11695-016-2095-2
HOW I DO IT
When and How to BOpen^ in Laparoscopic or Robotic Surgery Kenneth B. Jones Jr 1
# Springer Science+Business Media New York 2016
Abstract Introduction Surgical training today is all about minimally invasive surgery. With little or no experience and/or confidence in rapid, emergent conversion to an open procedure, how does the surgeon expeditiously do so? Objectives The intent of this paper is to help those inexperienced in Bopen^ techniques to quickly recognize the need for same and rapidly open and temporarily control an acute hemorrhage or significant problem requiring more than the tips of laparoscopic instruments. Methods The left subcostal or high transverse incision has been used by this author and several others with an experience of several thousand open cases. The author’s emergent technique includes a 3-cm mid-line incision from the xiphoid inferiorly, extending into a 135° left subcostal Bhockey stick^ approximately 12 cm in length, large enough for the surgeon’s fist to rapidly apply a tamponading moist lap sponge. Extension of the incision and rectus muscle bleeding is then controlled before proceeding. Results This author has used the left subcostal incision in over 4000 bariatric cases over a 30-year career with an incisional hernia and major wound infection rates of less than 1 %. Conclusion Today, the laparoscope has virtually replaced all open GS visceral techniques which are de-emphasized in surgical training programs. This author’s experience demonstrates a rapid fire technique, which will assist the inexperienced open surgeon in dealing with a very treatable acute
* Kenneth B. Jones, Jr [email protected]
1
LSU Health Sciences Center, CHRISTUS Shreveport-Bossier Health System, Shreveport, LA, USA
complication and preventing a long-term disaster with a huge mid-line wound infection, dehiscence, and ultimate hernia. Keywords Laparoscopic to open surgery . Avoiding wound complications . Open bariatric surgery . Left sub-costal incision . Bariatric surgical incisions
Background and Introduction BMinimally invasive^ an operative procedure which is safer, quicker, less painful, and will get one back to his or her work or usual activities much sooner than an open incision. Laparoscopic surgery had its origins over 30 years ago, for cholecystectomies, Nissen fundoplications, inguinal and other abdominal wall hernias, colon and rectal surgery, and even pancreatic surgery. Bariatric surgery has now been done successfully laparoscopically for over 20 years. At the 22nd annual ASBS meeting in Orlando in 2005, this author and 15 colleagues presented a paper comparing over 25, 000 open cases to several thousand laparoscopic cases drawn from the world literature at that time. Other than wound problems, there was no significant difference in complications, and the leak rate was
HOW I DO IT
When and How to BOpen^ in Laparoscopic or Robotic Surgery Kenneth B. Jones Jr 1
# Springer Science+Business Media New York 2016
Abstract Introduction Surgical training today is all about minimally invasive surgery. With little or no experience and/or confidence in rapid, emergent conversion to an open procedure, how does the surgeon expeditiously do so? Objectives The intent of this paper is to help those inexperienced in Bopen^ techniques to quickly recognize the need for same and rapidly open and temporarily control an acute hemorrhage or significant problem requiring more than the tips of laparoscopic instruments. Methods The left subcostal or high transverse incision has been used by this author and several others with an experience of several thousand open cases. The author’s emergent technique includes a 3-cm mid-line incision from the xiphoid inferiorly, extending into a 135° left subcostal Bhockey stick^ approximately 12 cm in length, large enough for the surgeon’s fist to rapidly apply a tamponading moist lap sponge. Extension of the incision and rectus muscle bleeding is then controlled before proceeding. Results This author has used the left subcostal incision in over 4000 bariatric cases over a 30-year career with an incisional hernia and major wound infection rates of less than 1 %. Conclusion Today, the laparoscope has virtually replaced all open GS visceral techniques which are de-emphasized in surgical training programs. This author’s experience demonstrates a rapid fire technique, which will assist the inexperienced open surgeon in dealing with a very treatable acute
* Kenneth B. Jones, Jr [email protected]
1
LSU Health Sciences Center, CHRISTUS Shreveport-Bossier Health System, Shreveport, LA, USA
complication and preventing a long-term disaster with a huge mid-line wound infection, dehiscence, and ultimate hernia. Keywords Laparoscopic to open surgery . Avoiding wound complications . Open bariatric surgery . Left sub-costal incision . Bariatric surgical incisions
Background and Introduction BMinimally invasive^ an operative procedure which is safer, quicker, less painful, and will get one back to his or her work or usual activities much sooner than an open incision. Laparoscopic surgery had its origins over 30 years ago, for cholecystectomies, Nissen fundoplications, inguinal and other abdominal wall hernias, colon and rectal surgery, and even pancreatic surgery. Bariatric surgery has now been done successfully laparoscopically for over 20 years. At the 22nd annual ASBS meeting in Orlando in 2005, this author and 15 colleagues presented a paper comparing over 25, 000 open cases to several thousand laparoscopic cases drawn from the world literature at that time. Other than wound problems, there was no significant difference in complications, and the leak rate was
