ABSTRACT

The spectrum of surgical procedures being adapted to a laparoscopic approach continues to expand and encompass traditional operations used for cancer staging. This chapter describes the procedures of appendectomy, hysterectomy (both standard and radical), omentectomy, palliative end colostomy, and lymphadenectomy (encompassing both para-aortic and pelvic lymph nodes). Appendectomy is frequently performed incidentally in association with other pelvic surgical procedures, or whenever pathological changes are identified as in patients with infection, endometriosis, or benign or malignant tumors. Hysterectomy is one of the most frequently performed major surgical procedures in women. The purpose of laparoscopic surgery for hysterectomy is to avoid the adverse effects of laparotomy, maintain the principles of oncologic surgery, and offer the advantages of a vaginal approach. Omentum frequently is involved with metastatic lesions whenever there is intra-abdominal spread of cancer. In palliative end colostomy, the fecal stream is diverted above the rectum. End sigmoid colostomy with a Hartmann pouch or distal exteriorization of the distal portion of the sigmoid colon as a fistula in lieu of the Hartmann pouch may be utilized. Since the initial descriptions of laparoscopic pelvic and para-aortic lymphadenectomy in the late 1980s and early 1990s, numerous reports have verified the feasibility and safety of this technique. Its advocates point to the better magnification, fewer complications, and superior visualization of the anatomy of blood vessels and lymph nodes provided by the video laparoscope in comparison with conventional techniques.