Book Review

Laparoscopic Surgery

N Engl J Med 1995; 332:131January 12, 1995

Article

Laparoscopic Surgery
Edited by Garth H. Ballantyne, Patrick F. Leahy, and Irvin M. Modlin. 710 pp., illustrated. Philadelphia, W.B. Saunders, 1994. $195. ISBN: 0-7216-6648-5

Reading the preface to Laparoscopic Surgery leads one to expect a textbook of laparoscopic surgery with a solid historical perspective. Its review of the evolution of and revolutions in surgical thought since 1543 provides an excellent background for understanding the “laparoscopic revolution.” It should be required reading for all surgical house officers. The historical introductions to most of the chapters in this book are also valuable.

Laparoscopic Surgery provides a comprehensive look at the current practice of performing minimally invasive surgery. The first section presents the fundamentals; discusses equipment, imaging, and electrosurgery; outlines some of the physiology of pneumoperitoneum; and reviews anesthesia and a broad spectrum of complications. The section on cautery includes a particularly strong discussion of the physics of electrocautery. All surgeons should know about this topic, but it is hard to find in textbooks. The discussion of pneumoperitoneum is also clear and informative. The chapters on anesthesia, the configuration of the operating room, and complications are repetitive, a problem that permeates the work. Because of insufficient editing, there is a great deal of redundancy throughout the book; the basics and the introductions to most chapters seem almost identical.

The editors are forthright about their relationship with the United States Surgical Corporation, and this is reflected in the discussion of techniques and instrumentation, although other manufacturers are well represented. In trying to be fair and informative, however, the authors bend over backward and resort to lists of manufacturers, leaving the reader without recommendations about the choice of instruments and without a sense of which might be superior. This omission may not be a major drawback given the rapidity with which instruments and manufacturers change and are outdated these days.

The second section of the book clearly discusses general techniques of laparoscopic surgery, with a step-by-step review of the basics of laparoscopic access, exposure, and suturing techniques. Sections 3, 4, 5, and 6 deal with specific organs and disease processes.

Section 7, which makes up almost half the book, deals with specific techniques of laparoscopic procedures ranging from esophagogastrectomy, vagotomy, and cholecystectomy to low anterior resection, herniorrhaphy, and pelvic lymphadenectomy, with much in between. Each of these well-organized chapters provides background on the selection of patients, preoperative evaluation, equipment, the positioning of the patient, video equipment, and trocars and includes a comprehensive discussion of the specific details of the procedure. Each chapter concludes with an appropriate discussion of complications. The best of these chapters use intraoperative photographs for illustration rather than the diagrams and drawings that could easily be found in any surgical atlas. The large portion of the book devoted to surgical pathophysiology could have been better treated in a textbook of surgery. This is particularly true since most of the information relayed in sections 3 through 6 is then duplicated in the chapters on technique. One finds the same information presented and the same references cited repeatedly. The final section, on postdoctoral training and credentials, rounds out the information necessary for teaching, learning, and evaluating basic and advanced laparoscopic techniques.

This textbook provides an excellent framework for thinking and learning about the current state of the art of laparoscopic surgery. However, including comprehensive discussions of the complex topics of basic surgical pathophysiology dilutes the focus on laparoscopy, and these sections seem better suited to another book. Because of this problem, and because of the editors' attempt to include the experience of many renowned authors, there is an inordinate amount of redundancy. Future editions will benefit from rigorous editing, which should make the strong points of this book more evident and better appreciated.

Jan Rothschild, M.D.
New England Medical Center, Boston, MA 02111

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