The second volume of Operative Manual of Endoscopic Surgery covers some of the operative endoscopic procedures which have been introduced into clinical practice since the publication of VoI. 1. In the general section, we have included an updated chapter on instrumentation and new chapters on anaesthetic manage­ ment of patients undergoing endoscopic surgery and on video image and record­ ing. Both topics are of importance to the practice of endoscopic surgery and have not been adequately covered in the reported literature. Volume 2 deals with endoscopic procedures)nthechest and abdomen. There have been significant advances in thoracoscopic surgery duririg the past 2 years; particular reference rs made to anatomical pulmonary resections and oesophageal resections. As far as the gastrointestinal trad is concerned, we have included gastric and allied operations but have not covered the colorectal region as we believe that more evaluation is needed before definitive accounts can be written on endoscopic colorectal resections, especially for cancer. For this reason, we have decided to defer this important topic to VoI. 3, which is in preparation. The same applies to laparoscopic repair of abdominal hernias. The same layout has been adopted as in VoI. 1 of the series, with heavy em­ phasis on illustrative representation of the operative steps and techniques. In the diagrams on sites of trocar/cannulae, we have indicated not only the site and size but also the functional role of each port.

The second volume of Operative Manual of Endoscopic Surgery covers some of the operative endoscopic procedures which have been introduced into clinical practice since the publication of VoI. 1. In the general section, we have included an updated chapter on instrumentation and new chapters on anaesthetic manage­ ment of patients undergoing endoscopic surgery and on video image and record­ ing. Both topics are of importance to the practice of endoscopic surgery and have not been adequately covered in the reported literature. Volume 2 deals with endoscopic procedures)nthechest and abdomen. There have been significant advances in thoracoscopic surgery duririg the past 2 years; particular reference rs made to anatomical pulmonary resections and oesophageal resections. As far as the gastrointestinal trad is concerned, we have included gastric and allied operations but have not covered the colorectal region as we believe that more evaluation is needed before definitive accounts can be written on endoscopic colorectal resections, especially for cancer. For this reason, we have decided to defer this important topic to VoI. 3, which is in preparation. The same applies to laparoscopic repair of abdominal hernias. The same layout has been adopted as in VoI. 1 of the series, with heavy em­ phasis on illustrative representation of the operative steps and techniques. In the diagrams on sites of trocar/cannulae, we have indicated not only the site and size but also the functional role of each port.

In putting together this manual of endoscopic surgery, we have sought to cover the three essential components of the new surgical approach: the technological aspects, the basic endoscopic surgical skills, and the operative techniques. Visualization of the operative field, exposure and execution of remote manipulations are dependent on op­ timal function of the ancillary apparatus without which endoscopic surgery cannot be practised. Familiarity of the surgeon with the basic physical principles of the various de­ vices employed in this technology-dependent form of surgery ensures safe use, pro­ longed equipment life and smooth execution of surgical endoscopic interventions. Equally important is the acquisition of the basic skills of endoscopic surgical practice, since these differ in several important respects from those of conventional open surgery. Mastery of the craft of endoscopic surgery requires a determined commitment to training and is no easy option, but once acquired is rewarded by the extreme profes­ sional satisfaction experienced when one witnesses the remarkable progress of patients who have undergone major surgical interventions, with minimal discomfort and pain, lower morbidity and rapid return to gainful employment. The new approach has taken the "sting" out of surgical treatment and made it more acceptable to our patients. Quite apart from cost considerations, this aspect alone justifies the extra effort and invest­ ment needed for the further advancement of endoscopic surgery. Our task in compiling this operative manual was thus an ambitious one.

2. Stone extraction via the T-tube 89 3. Endoscopic method 89 4. Preparation for stone extraction 90 5. Technique 90 6. Results 91 7. Complications 91 8. Discussion 91 Index of Subjects 99 CHAPTER 1 INTRODUCTION This book was conceived as a descriptive atlas of most reliable indication for common bile duct ex­ routine biliary surgery i. e. , cholecystectomy and ploration. The cholangioscope allows a visual ex­ exploration of the common bile duct. For the pro­ ploration of the biliary tree and permits the re­ ject the two authors worked together for one week moval of common bile duct calculi and other as biopsy under direct visual con­ at Ninewells Hospital and Medical School, Dundee procedures such on a series of patients with biliary tract disease trol. Both procedures have been described in detail especially selected for the exercise. With the con­ with emphasis on the practical aspects of their use. sent of the Tayside Health Board and the patients The era of blind bilary surgery is over and the concerned, all the operations and peri-operative sooner this message is received by all concerned, procedures were filmed by the photographic mem­ the better the outcome of biliary surgical practice bers of the team, Mr. and Mrs. Paz-Partlow. Ad­ overall. ditional case material has been obtained from It has not been our intention to produce a com­ Cedars Sinai Medical Center, Los Angeles.

The second volume of Operative Manual of Endoscopic Surgery covers some of the operative endoscopic procedures which have been introduced into clinical practice since the publication of VoI. 1. In the general section, we have included an updated chapter on instrumentation and new chapters on anaesthetic manage­ ment of patients undergoing endoscopic surgery and on video image and record­ ing. Both topics are of importance to the practice of endoscopic surgery and have not been adequately covered in the reported literature. Volume 2 deals with endoscopic procedures)nthechest and abdomen. There have been significant advances in thoracoscopic surgery duririg the past 2 years; particular reference rs made to anatomical pulmonary resections and oesophageal resections. As far as the gastrointestinal trad is concerned, we have included gastric and allied operations but have not covered the colorectal region as we believe that more evaluation is needed before definitive accounts can be written on endoscopic colorectal resections, especially for cancer. For this reason, we have decided to defer this important topic to VoI. 3, which is in preparation. The same applies to laparoscopic repair of abdominal hernias. The same layout has been adopted as in VoI. 1 of the series, with heavy em­ phasis on illustrative representation of the operative steps and techniques. In the diagrams on sites of trocar/cannulae, we have indicated not only the site and size but also the functional role of each port.

The second volume of Operative Manual of Endoscopic Surgery covers some of the operative endoscopic procedures which have been introduced into clinical practice since the publication of VoI. 1. In the general section, we have included an updated chapter on instrumentation and new chapters on anaesthetic manage­ ment of patients undergoing endoscopic surgery and on video image and record­ ing. Both topics are of importance to the practice of endoscopic surgery and have not been adequately covered in the reported literature. Volume 2 deals with endoscopic procedures)nthechest and abdomen. There have been significant advances in thoracoscopic surgery duririg the past 2 years; particular reference rs made to anatomical pulmonary resections and oesophageal resections. As far as the gastrointestinal trad is concerned, we have included gastric and allied operations but have not covered the colorectal region as we believe that more evaluation is needed before definitive accounts can be written on endoscopic colorectal resections, especially for cancer. For this reason, we have decided to defer this important topic to VoI. 3, which is in preparation. The same applies to laparoscopic repair of abdominal hernias. The same layout has been adopted as in VoI. 1 of the series, with heavy em­ phasis on illustrative representation of the operative steps and techniques. In the diagrams on sites of trocar/cannulae, we have indicated not only the site and size but also the functional role of each port.

In putting together this manual of endoscopic surgery, we have sought to cover the three essential components of the new surgical approach: the technological aspects, the basic endoscopic surgical skills, and the operative techniques. Visualization of the operative field, exposure and execution of remote manipulations are dependent on op­ timal function of the ancillary apparatus without which endoscopic surgery cannot be practised. Familiarity of the surgeon with the basic physical principles of the various de­ vices employed in this technology-dependent form of surgery ensures safe use, pro­ longed equipment life and smooth execution of surgical endoscopic interventions. Equally important is the acquisition of the basic skills of endoscopic surgical practice, since these differ in several important respects from those of conventional open surgery. Mastery of the craft of endoscopic surgery requires a determined commitment to training and is no easy option, but once acquired is rewarded by the extreme profes­ sional satisfaction experienced when one witnesses the remarkable progress of patients who have undergone major surgical interventions, with minimal discomfort and pain, lower morbidity and rapid return to gainful employment. The new approach has taken the "sting" out of surgical treatment and made it more acceptable to our patients. Quite apart from cost considerations, this aspect alone justifies the extra effort and invest­ ment needed for the further advancement of endoscopic surgery. Our task in compiling this operative manual was thus an ambitious one.

2. Stone extraction via the T-tube 89 3. Endoscopic method 89 4. Preparation for stone extraction 90 5. Technique 90 6. Results 91 7. Complications 91 8. Discussion 91 Index of Subjects 99 CHAPTER 1 INTRODUCTION This book was conceived as a descriptive atlas of most reliable indication for common bile duct ex­ routine biliary surgery i. e. , cholecystectomy and ploration. The cholangioscope allows a visual ex­ exploration of the common bile duct. For the pro­ ploration of the biliary tree and permits the re­ ject the two authors worked together for one week moval of common bile duct calculi and other as biopsy under direct visual con­ at Ninewells Hospital and Medical School, Dundee procedures such on a series of patients with biliary tract disease trol. Both procedures have been described in detail especially selected for the exercise. With the con­ with emphasis on the practical aspects of their use. sent of the Tayside Health Board and the patients The era of blind bilary surgery is over and the concerned, all the operations and peri-operative sooner this message is received by all concerned, procedures were filmed by the photographic mem­ the better the outcome of biliary surgical practice bers of the team, Mr. and Mrs. Paz-Partlow. Ad­ overall. ditional case material has been obtained from It has not been our intention to produce a com­ Cedars Sinai Medical Center, Los Angeles.