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Minimally Invasive Surgical Techniques for Cancers of the Small Intestine

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Abstract

The rarity of small intestinal malignancies and the advanced nature at presentation have traditionally limited the use of laparoscopic operations in dealing with cancers of the small intestine. However, in the recent past, with advanced experience and improved technology, laparoscopic surgery for these disorders is gaining popularity in mainstream practice. This chapter provides an insight into the disease processes, diagnosis, and treatment of small intestinal neoplasms, while giving a step-by-step description on performing these complex procedures using minimally invasive surgical techniques.

Keywords

  • Small bowel cancer
  • Laparoscopic
  • Jejunum
  • Ileum
  • Technique

Dilendra H. Weerasinghe is supported by a grant from the Foundation for Surgical Fellowships.

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  • DOI: 10.1007/978-1-4939-1893-5_14
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Authors and Affiliations

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Corresponding author

Correspondence to Michael S. Nussbaum M.D., F.A.C.S. .

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In this video, the surgeon demonstrates his approach to minimally invasive surgical techniques for cancers of the jejunum and ileum. (WMV 57192 kb)

Key Operative Steps

Key Operative Steps

  1. 1.

    Access peritoneal cavity by Veress needle or open (Hasson) approach.

  2. 2.

    Identify the small bowel segment to be resected.

  3. 3.

    Elevate the transverse colon, locate the ligament of Treitz, and run the small bowel.

  4. 4.

    Create a mesenteric window with 5 cm proximal and distal margins.

  5. 5.

    Divide the proximal intestine with a laparoscopic linear stapler.

  6. 6.

    Divide the mesentery with an endoscopic bipolar or ultrasonic energy device.

  7. 7.

    Divide the distal intestine with a laparoscopic linear stapler.

  8. 8.

    Align the two intestinal segments side by side with stay sutures.

  9. 9.

    Create an enterotomy at each end of the intestinal segments.

  10. 10.

    Negotiate the jaws of the linear stapler into the lumen and create a functional end-to-end anastomosis.

  11. 11.

    Close the enterotomy with a linear stapler or with a running suture.

  12. 12.

    Close the mesenteric defect with a running suture.

  13. 13.

    Extract the specimen.

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Ahmed, B., Weerasinghe, D.H., Nussbaum, M.S. (2015). Minimally Invasive Surgical Techniques for Cancers of the Small Intestine. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_14

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_14

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