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Minimally invasive approach to chagasic megacolon: laparoscopic rectosigmoidectomy with posterior end-to-side low colorectal anastomosis. Surg Laparosc Endosc Percutan Tech 2014; 24:207-12. [PMID: 24710265 DOI: 10.1097/sle.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The effectiveness of anterior resection for the surgical treatment of Chagasic megacolon and the advantages of laparoscopy for performing colorectal surgery are well known. However, current experience with laparoscopic surgery for Chagasic megacolon is restricted. Moreover, associated long-term results remain poorly analyzed. The aims of the present study were to ascertain the immediate results of laparoscopic anterior resection for the surgical treatment of Chagasic megacolon, to identify risk factors associated with adverse outcomes, and to settle late results. A retrospective review of a prospective database was conducted. Between November 2000 and September 2012, 44 patients with Chagasic megacolon underwent laparoscopic anterior resection with posterior end-to-side low colorectal anastomosis. Fifteen (34.1%) patients were male. Mean age was 51.6 years (31 to 77 y). The mean body mass index (BMI) was 22.9 kg/m (16.9 to 36.7 kg/m). Thirty-four previous abdominal operations had been performed. Mean operative time was 265 minutes (105 to 500 min). Four surgeons operated on all cases. Surgeon's experience with the operation was not associated with surgical time (P=0.36: linear regression). Mean operative time between patients with and without previous abdominal surgery was similar (237.7 vs. 247.5 min: P=0.78). There was no association between BMI and the duration of the operation (P=0.22). Intraoperative complications occurred in 2 (4.5%) cases. Conversion was necessary in 3 (6.8%) cases. There was no association between conversion and previous abdominal surgery (P=0.56) or between conversion and surgeon's experience (P=0.43). However, a significant association (P=0.01) between BMI and conversion was observed. Postoperative complications occurred in 10 (22.7%) cases. Anastomotic-related complications occurred in 4 cases. Two of them required diversion ileostomy. Restoration of transanal evacuation was achieved in all cases. Mean duration of postoperative hospital stay was 9.8 days (4 to 45 d). Of 19 patients with known clinical late follow-up, only 1 (5.3%) reported use of enemas and 5 (26.3%) reported use of laxatives. Thirteen (68.4%) patients reported daily bowel movements. There was no association between postoperative complications and use of laxatives (P=0.57). It was concluded that laparoscopic anterior resection for Chagasic megacolon is safe. Obesity was a risk factor for conversion. Restoration of transanal evacuation after surgical treatment of infectious complications was achieved. Minimally invasive surgery for Chagasic megacolon is associated with satisfactory late intestinal function with no significant constipation relapse.
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Coimbra C, Bouffioux L, Kohnen L, Deroover A, Dresse D, Denoël A, Honoré P, Detry O. Laparoscopic repair of colonoscopic perforation: a new standard? Surg Endosc 2010; 25:1514-7. [PMID: 20972581 DOI: 10.1007/s00464-010-1427-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 09/30/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Scientific evidence demonstrating interest in the laparoscopic approach for surgical repair of colonoscopic perforations is still lacking. The authors retrospectively reviewed the records of 43 patients who suffered from colonic perforations after colonoscopy between 1989 and 2008 in two tertiary centers in order to compare the results of the laparoscopic and the open approaches to repair. METHODS The patients' demographic data, perforation location, therapy, and outcome were recorded from the medical charts. Forty-two patients were managed operatively (19 laparoscopies and 23 laparotomies). In three patients who underwent explorative laparoscopy, the procedure had to be converted to laparotomy due to surgical difficulties. The patients who underwent laparotomy management had a longer period between the colonoscopy and the surgery (P=0.056) and more stercoral contaminations. RESULTS The mean hospital stay was shorter for the laparoscopy group (P=0.02), which had fewer postoperative complications (P=0.01) and no mortality (NS). CONCLUSION This series demonstrates that early laparoscopic management of colonoscopic perforation is safe. Laparoscopic management may lead to reduced surgical and psychological stress for the patient because of its low morbidity and mortality rates and shorter hospital stay. However, the procedure should be converted to a laparotomy if necessary.
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Affiliation(s)
- Carla Coimbra
- Department of Abdominal Surgery and Transplantation, CHU de Liège, Sart Tilman B35, 4000, Liège, Belgium
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Reply to letter by Engledow et al. Surg Endosc 2008. [DOI: 10.1007/s00464-008-0092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brun M, Oliveira S, Messina S, Stedile R, Oliveira R. Laparoscopic cystotomy for urolith removal in dogs: three case reports. ARQ BRAS MED VET ZOO 2008. [DOI: 10.1590/s0102-09352008000100015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The use of laparoscopic surgery for the removal of cystic calculi in three dogs was reported. Three trocars were used, one in the ventral midline (10mm) and the others in the right (10mm) and left (5mm) flanks. The calculi were removed and the bladder was sutured with intracorporeal technique in two layers, a simple continuous pattern and interrupted or continuous Lembert pattern. No postoperative complications were observed. One patient had a recurrence of urolithiasis, attributed to inadequate conservative treatment and to the lack of an appropriate diet. It was submitted to another similar videolaparoscopic cystotomy without complication. The proposed technique is appropriate and an alternative to conventional cystotomy for treatment of canine vesical urolithiasis.
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Affiliation(s)
| | | | | | - R. Stedile
- Universidade Federal do Rio Grande do Sul
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MUKAI M, SADAHIRO S, TOKUNAGA N, ISHIDA H, MAKUUCHI H, TAJIMA T, MITOMI T. Clinical Experiences with Laparoscopic Colectomy. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1997.tb00452.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Masaya MUKAI
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Sotaro SADAHIRO
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Nobuhiro TOKUNAGA
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hideki ISHIDA
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyasu MAKUUCHI
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Tomoo TAJIMA
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Toshio MITOMI
- Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan
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Jamali FR, Fölscher DJ, Bailey CMH, Leroy J, Marescaux J. Rapidly reversible closure of mini-laparotomy during laparoscopic colorectal surgery. Am J Surg 2007; 194:556-8. [PMID: 17826079 DOI: 10.1016/j.amjsurg.2006.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 11/07/2006] [Accepted: 11/07/2006] [Indexed: 12/21/2022]
Abstract
Specimen extraction has been described as the "Achilles heel" of laparoscopic colonic surgery. In most cases, this extraction is performed via a tailored, appropriately placed mini-laparotomy incision. Immediate closure of this mini-laparotomy following specimen extraction wastes operative time and prevents the incision from being used for access later on in the procedure. The use of hand assist devices to allow reversible closure has been reported, not without its own drawbacks including cost and difficulty of use. We hereby describe a technique of creating a rapidly reversible closure of the mini-laparotomy incision using a simple wound protector. This technique is simple, easily reproducible, inexpensive, and effective, leading to time savings in the operating room when applied properly.
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Affiliation(s)
- Faek R Jamali
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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7
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Abstract
Minimally invasive surgery is rapidly becoming the desired surgical standard,
especially for pediatric patients. Infants and children are a particular technical
challenge, however, because of the small size of target anatomical structures and
the small surgical workspace. Computer-assisted robot-enhanced surgical
telemanipulators may overcome these challenges by facilitating surgery in a small
workspace. We studied the feasibility of performing robotic endoscopic neck surgery
on a porcine model of the human infant neck. The study design was a prospective,
feasibility pilot study of a small cohort for proof of concept and for a survival
model. Sixteen non-survival piglets weighing 4.5–10 kg were used to develop the
surgical approach and operative technique. Eight piglets aged 3–6 weeks old and
weighing 4.0–9.1 kg underwent survival thyroidectomy by a cervical endoscopic
approach using the Zeus surgical robot, which includes the Aesop endoscope holder
and “Microwrist” microdissecting instruments. We succeeded in performing endoscopic
robotic neck surgery on a piglet as small as 4 kg, in an operative pocket as small
as 2 cm3. Total incision length for all three ports was
≤23 mm. There were no major complications, no major robotic instrument malfunctions
or breakages, and no procedures required conversion to open surgery. These results
support the feasibility of robotic endoscopic neck surgery on a neck the size of a
human infant’s.
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Terris DJ, Haus BM, Gourin CG, Lilagan PE. Endo-robotic resection of the submandibular gland in a cadaver model. Head Neck 2006; 27:946-51. [PMID: 16155920 DOI: 10.1002/hed.20273] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By means of a prospective, nonrandomized investigation, we evaluated the feasibility of performing endo-robotic resection of the submandibular gland in a cadaver model and compared the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique. METHODS Procedural times were recorded in a consecutive series of 11 endoscopic submandibular gland resections using the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA) and a modified endoscopic surgical approach previously developed in a porcine model. The presence of neurovascular injury was assessed postoperatively, and the specimens were examined histologically. RESULTS Eleven endo-robotic submandibular gland resections were successfully performed in six cadavers (no conversions to open resection were necessary). The median duration of the procedures was 48 minutes (range, 33-82 minutes). Creation of the operative pocket took an average (+/-SD) of 12.2 +/- 5.3 minutes, assembly of the robot required 9.3 +/- 4.1 minutes, and the mean time for submandibular gland resection was 29.4 +/- 8.9 minutes. The time required for robotic assembly was offset by the reduced operative time necessary compared with conventional endoscopic resection. Histologic examination confirmed the presence of normal glandular architecture, without evidence of excessive mechanical or thermal injury. There were no cases of apparent neurovascular injury. CONCLUSIONS Robotically enhanced endoscopic surgery in the neck is feasible and offers a number of compelling advantages over conventional endoscopic neck surgery. Clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice.
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Affiliation(s)
- David J Terris
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, 1120 Fifteenth Street, Augusta, Georgia 30912-4060, USA.
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Kitano S, Kitajima M, Konishi F, Kondo H, Satomi S, Shimizu N. A multicenter study on laparoscopic surgery for colorectal cancer in Japan. Surg Endosc 2006; 20:1348-52. [PMID: 16865630 DOI: 10.1007/s00464-004-8247-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 03/28/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Laparoscopic colectomy for malignant disease technically is feasible but not widely accepted because there are no large-series studies or data on long-term outcomes. A retrospective, multicenter study investigating a large series of patients was conducted in Japan to evaluate preliminary long-term results of laparoscopic surgery for colorectal cancer. METHODS The study group comprised 2,036 patients who underwent laparoscopic colorectal resection April 1993 to August 2002 in 12 participating surgical units (Japanese Laparoscopic Surgery Study Group). RESULTS Of the 1,495 patients with colon cancer, 781 (59%) had International Union Against Cancer (UICC) stage I, 248 (19%) had stage II, and 284 (22%) had stage III disease. Cancer recurred for 61 (4.1%) of 1,367 curatively treated patients (median follow-up period, 32 months; range, 6-125 months). The 5-year survival rate was 96.7% for stage I, 94.8% for stage II, and 79.6% for stage III disease. Of the 541 patients with rectal cancer, 220 (56%) had stage I, 62 had (16%) stage II, and 108 (28%) had stage III disease. Cancer recurred for 30 (5.6%) of 476 curatively treated patients (median follow-up period, 25 months; range 6-102 months). The 5-year survival rate was 95.2% for stage I, 85.2% for stage II, and 80.8% for stage III disease. CONCLUSIONS The findings indicate that laparoscopic surgery for colorectal cancer yields an oncological outcome as good as that reported for conventional open surgery in the Japanese Registry for all disease stages.
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Affiliation(s)
- S Kitano
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Idaigaoka, Yufu, Oita, 879-5593, Japan
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Stage JG, Schulze S, Møller P, Overgaard H, Andersen M, Rebsdorf-Pedersen VB, Nielseni HJ. Prospective randomized study of laparoscopic versus
open colonic resection for adenocarcinoma. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02516.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Do LV, Laplante R, Miller S, Gagné JP. Laparoscopic colon surgery performed safely by general surgeons in a community hospital: a review of 154 consecutive cases. Surg Endosc 2005; 19:1533-7. [PMID: 16222465 DOI: 10.1007/s00464-005-0079-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 07/19/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND The primary end point of this study was documentation of the feasibility, safety, and benefits of laparoscopic colon resection (LCR) performed by general surgeons in a community hospital. METHODS The charts of 154 patients who underwent LCR between March 1998 and August 2003 by a group of three surgeons working in a community hospital were reviewed. Data extracted from the charts included patients' demographics, surgical indications and procedures, conversion rate, history, operative time, postoperative recovery time, and complication rates. RESULTS Of the 154 patients, 70 were men. The mean age of the patients was 60 years. Overall, 62% of the patients had a history of prior abdominal surgery. In the majority of cases (77%), LCR was performed for benign disease. Segmental resection involving the left colon was performed for 122 patients, and right hemicolectomy was performed for 32 patients. The rates of conversion were 9.6% for open surgery and 12% for diverticulitis (n = 83). For LCR, the median operative time was 120 min, and the median hospital stay was 5 days. The complication rate was 21.6% for LCR, and the mortality rate was 2.1%. CONCLUSION The outcomes for LCR performed by a team of general surgeons working together in a community hospital are similar to the historical results from academic health science centers.
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Affiliation(s)
- L V Do
- Department of Surgery, Hôpital Sainte-Croix, Drummondville, Quebec, Canada
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Abstract
OBJECTIVES Access to the thyroid compartment has traditionally been achieved by a Kocher incision followed by subplatysmal flap elevation and strap muscle retraction. A combination of novel access techniques was used to allow for minimally invasive thyroidectomy (MITh). METHODS AND MATERIALS A prospective, nonrandomized evaluation of consecutive patients undergoing thyroidectomy was performed. A minimally invasive incision (< or =6 cm) was used in conjunction with the Sofferman technique (transection of the strap muscles) and videoendoscopic assistance to perform hemithyroidectomy or total thyroidectomy in eligible patients. Prospectively collected data include age, sex, pathology, incision length, duration of surgery, and blood loss and complications were considered. RESULTS Forty-four patients underwent 48 thyroid surgeries between September 2003 and May 2004. There were 13 men and 31 women, with a mean age of 41.9 (range 19-73) years. Thirty-one (64.6%) of these were eligible to be performed by MITh; the remainder (n = 17, 35.4%) underwent conventional thyroidectomy. The mean incision length in the MITh cohort was 4.9 +/- 1.0 cm compared with 9.1 +/- 1.5 cm for conventional thyroidectomy. The mean surgical time for minimally invasive hemithyroidectomy was 115.7 minutes (n = 23), and for total thyroidectomy was 147.4 minutes (n = 8). There were no cases of permanent hypocalcemia or recurrent laryngeal nerve paralysis in either group. No patients in the MITh group had to be converted to a conventional thyroidectomy. The cosmetic results were excellent, although one patient in the MITh group developed a mildly hypertrophic scar that responded to triamcinolone injection. CONCLUSIONS MITh is safe in carefully selected patients and probably results in more rapid wound healing. The cosmetic result is superior to that achieved with conventional thyroidectomy.
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Affiliation(s)
- David J Terris
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia 30912-4060, USA.
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Kwok SY, Chung CCC, Tsang WWC, Li MKW. Laparoscopic resection for rectal cancer in patients with previous abdominal surgery: A comparative study. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1442-2034.2004.00219.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
OBJECTIVE To evaluate the current place of laparoscopy in the management of colorectal disease. METHOD A literature search was undertaken on Medline between the period 1991 and 2002. RESULTS From the literature there is good evidence that the laparoscopic approach is associated with at least some short-term advantages. Improved cosmesis and better patient's satisfaction are also evident. Because of this laparoscopy has been widely employed in various benign conditions. Among others, laparoscopic stoma formation, laparoscopic resection for diverticular disease and Crohn's disease, laparoscopic rectopexy, as well as laparoscopic assisted reversal of Hartmann's procedure were commonly reported. As port site recurrence and oncological safety are of less concern, there have been increasing reports on laparoscopic resection for colorectal cancer. Although long-term follow up data is still limited, results of large prospective studies as well as various randomized trials show that recurrence and survival rates of the laparoscopic approach were at least comparable to open surgery. As experience and confidence accumulates, there are also increasing reports on technically demanding, laparoscopic sphincter-saving rectal excision. Articles on functional aspects following this type of resection also start to appear, which might be one of the future directions. CONCLUSION The applicability of laparoscopy to colorectal disease continues to expand. Laparoscopic approach should be considered for patients with benign conditions. For colorectal cancer, results from randomized trials so far have been favourable. Hence, the authors suggest the utility of laparoscopy in potentially curable cancer can also be judiciously relaxed.
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Affiliation(s)
- C C Chung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
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Menenakos E, Hahnloser D, Nassiopoulos K, Chanson C, Sinclair V, Petropoulos P. Laparoscopic surgery for fistulas that complicate diverticular disease. Langenbecks Arch Surg 2003; 388:189-93. [PMID: 12836027 DOI: 10.1007/s00423-003-0392-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 05/21/2003] [Indexed: 01/27/2023]
Abstract
BACKGROUND Diverticular disease is complicated by colovesical and colovaginal fistulas in 4-20% of patients. Laparoscopic surgery is usually reserved for selected cases of uncomplicated disease. The aim of this study was to assess the efficacy and effectiveness of laparoscopic surgery in the treatment of those patients. METHODS Eighteen patients, 15 with colovesical fistulas and three with colovaginal fistulas, were operated on laparoscopically. Prospectively collected data, associated with technical feasibility, short-term outcome and effectiveness, were analysed. RESULTS Twelve sigmoidectomies, four extended left colectomies and two segmentectomies were performed. Fistulas were treated with simple dissection or mechanical division, and the bladder wall was repaired in two patients. Mean operating time was 237 min (range 165-330). There was one conversion (5.5%) and no post-operative death. Morbidity was 27.7% and included one major complication. Return of gastrointestinal function occurred 2.9 days post-operatively, and the mean hospital stay was 10 days after surgery. During the 5.1-year follow-up period there was one fistula recurrence (5.5%) and no recurrent diverticulitis. CONCLUSIONS Laparoscopic one-stage surgery was technically feasible and safe, with low morbidity. Effectiveness appears favourable when compared with open surgery, but prospective randomized studies are necessary to support such a conclusion.
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Affiliation(s)
- Evangelos Menenakos
- Department of General Surgery, Hôpital Cantonal de Fribourg, Fribourg, Switzerland.
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Campos FG. Complications and conversions in laparoscopic colorectal surgery: results of a multicenter Brazilian trial. Surg Laparosc Endosc Percutan Tech 2003; 13:173-9. [PMID: 12819501 DOI: 10.1097/00129689-200306000-00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This multicentric national registry reports the experience of 16 Brazilian surgical teams in laparoscopic colorectal surgery. Between 1992 and 2001, 1966 patients (941 men [47.8%] and 1025 women [52.1%]) were operated on, with ages ranging from 1 to 94 years (average, 55.9 years). Benign diseases were diagnosed in 1170 patients (59.5%). There were 82 (4.2%) reported intraoperative complications (range, 2.0-9.8%), 209 (10.6%) conversions to laparotomy (range, 1.4-23.5%), and 383 (19.4%) postoperative complications (8.0-29.6%). Mortality occurred in 29 patients (1.5%). During the early experience (first 50 operated patients in each surgical team), there were more intraoperative complications (8.1% x 1.7%), conversions (16.6% x 6.8%) and postoperative complications (25% x 16%). After an average follow-up of 26.5 months, 91 tumor recurrences (13.8%) were reported (0.45% parietal recurrences). There was no incisional recurrence in the ports used to withdraw the pathologic specimen. The Brazilian experience is significant, with complication and mortality rates similar to those reported in literature. The results indicate that experience reduces complication and mortality rates. Oncological results are satisfactory and the incidence of parietal recurrence is low and similar to other series.
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De Chaisemartin C, Panis Y, Mognol P, Valleur P. [Laparoscopic sigmoid resection for diverticulitis: is learning phase associated with increased morbidity?]. ANNALES DE CHIRURGIE 2003; 128:81-7. [PMID: 12657543 DOI: 10.1016/s0003-3944(02)00032-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To assess retrospectively the results of laparoscopic sigmidectomy for diverticulitis, with intent to treat, in 58 consecutive patients operating by one surgeon compared with a control group operating by laparotomy. MATERIALS AND METHODS From 1995 to 2001, 90 consecutive patients undergoing elective sigmoid resection for diverticulitis were divided into 3 groups: laparotomy (Group 1 : n = 32), first cases of laparoscopy (Group 2 : n = 29) and last cases of laparoscopy (Group 3 : n = 29). These 3 groups were similar according to age, sex, Body Mass Index (BMI), American society of anesthesia score (ASA), previous abdominal surgery, number of attacks of diverticulitis, and time between last attack and surgery. Following criteria were studied: operating time, conversation rate, intra-operative and post-operative morbidity, return of intestinal transit, and hospital stay. RESULTS During laparoscopy, conversion was mandatory in 24% of the cases (7/29) in group 2 and 14% in group 3 (4/29; NS). No intra-operative morbidity was noted in the 58 laparoscopies. Mean operative time was 240 min in group 1, 259 min in group 2, and 241 min in group 3 (NS). Postoperative morbidity was observed in 31% of patients in group 1, 34% in group 2, and 10% in group 3 (p = 0.02). Returm of intestinal transit and oral ingestion and mean hospital stay were significantly shorter in group 2 and group 3 versus group 1 (p < 0.05). CONCLUSION Our results confirm previous data demonstrating faisability of laparoscopic sigmodectomy for diverticulitis and its benefice in terms of return of intestinal transit and hospital stay. Furthermore, our study suggest that when surgeon gain experience, conversion rate, morbidity and operative time can be reduced.
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Affiliation(s)
- C De Chaisemartin
- Service de chirurgie générale et digestive, hôpital Lariboisière, 2, rue Ambroise-Paré, 75475 cedex 10, Paris, France
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The Incidence of Positive Peritoneal Cytology in Colon Cancer: A Prospective Randomized Blinded Trial. Am Surg 2002. [DOI: 10.1177/000313480206801117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many investigators have attempted to explain the suspected increased incidence of port site metastasis in patients undergoing laparoscopic colorectal resections for cancer with animal models in which cancer is simulated by injection of a tumor slurry into the peritoneal cavity. This approach makes the basic assumption that all patients with colorectal malignancies have viable cancer cells freely circulating within the peritoneal cavity. Recent reports in open colorectal resections have conflicting results. Some suggest that the true incidence is negligible and related to advanced-stage cancers whereas others implicate a much higher incidence. We initiated a prospective blinded trial to establish the true incidence of malignant peritoneal cytology in colorectal cancer. One hundred eight consecutive colon resections underwent conventional peritoneal cytologic evaluation. The patients included those with inflammatory conditions of the colon as well as malignant disease. The cytopathologist was blinded as to the indications for surgery as well as the final pathology result. In only one case—stage IV rectal cancer with peritoneal carcinomatosis—was the cytologic specimen positive. Malignant cytology appears to be an infrequent occurrence and is restricted to advanced-stage cancer.
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Chapman AE, Levitt MD, Hewett P, Woods R, Sheiner H, Maddern GJ. Laparoscopic-assisted resection of colorectal malignancies: a systematic review. Ann Surg 2001; 234:590-606. [PMID: 11685021 PMCID: PMC1422083 DOI: 10.1097/00000658-200111000-00003] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of laparoscopic-assisted resection of colorectal malignancies with open colectomy. METHODS Two search strategies were devised to retrieve literature from the Medline, Current Contents, Embase, and Cochrane Library databases until July 1999. Inclusion of papers was determined using a predetermined protocol, independent assessments by two reviewers, and a final consensus decision. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series, or case reports. Fifty-two papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding, and chance. RESULTS Little high-level evidence was available. Laparoscopic resection of colorectal malignancy was more expensive and time-consuming, but little evidence suggests high rates of port site recurrence. The new procedure's advantages revolve around early recovery from surgery and reduced pain. CONCLUSIONS The evidence base for laparoscopic-assisted resection of colorectal malignancies is inadequate to determine the procedure's safety and efficacy. Because of inadequate evidence detailing circumferential marginal clearance of tumors and the necessity of determining a precise incidence of cardiac and other major complications, along with wound and port site recurrence, it is recommended that a controlled clinical trial, ideally with random allocation to an intervention and control group, be conducted. Long-term survival rates need to be a primary aim of such a trial.
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Affiliation(s)
- A E Chapman
- Australian Safety & Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S) project, Royal Australasian College of Surgeons, Adelaide, South Australia
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Faynsod M, Stamos MJ, Arnell T, Borden C, Udani S, Vargas H. A Case-Control Study of Laparoscopic versus Open Sigmoid Colectomy for Diverticulitis. Am Surg 2000. [DOI: 10.1177/000313480006600908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Laparoscopic sigmoid colectomy (LSC) for diverticular disease accounts for a limited number of laparoscopic colon cases performed nationally because of the technical challenge it presents. Our objective was to determine the feasibility and impact of the laparoscopic approach in elective sigmoid colectomy for diverticular disease and to compare these results with those of the open approach. Twenty elective laparoscopic sigmoid colectomies (LSCs) were performed for diverticulitis between April 1992 and July 1999 at a university-affiliated urban hospital. A case-control study was performed comparing LCS with a matched control group of conventional open sigmoidectomies. Fourteen of 20 sigmoidectomies were successfully completed laparoscopically. The mean operative time for LSC was similar to that for open sigmoid colectomy (251 vs 243 minutes). There was earlier return to oral intake in the LSC group (1 vs 5 days; P < 0.001). The mean length of stay was significantly shorter ( P = 0.029) in LSC (4.8 days) versus open sigmoid colectomy (7.8 days). Conversion to open sigmoidectomy extended hospital stay to 8.16 days. The overall complication rate was 10 per cent in both groups. We conclude that LSC can be performed effectively and with a low complication rate for diverticular disease. LSC provides the benefit of quicker return of bowel function and shorter hospitalization.
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Affiliation(s)
| | | | | | | | - Sejal Udani
- Harbor UCLA Medical Center, Torrance, California
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21
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Abstract
The use of laparoscopic surgery to treat colon cancer has been well studied; however, the specific use of laparoscopic colectomy for Dukes A colon cancer has not been evaluated. The data of laparoscopic colectomy were compared with those of conventional open colectomy, and the surgical results of patients who underwent surgery for Dukes A colon cancer were evaluated. Between November 1993 and October 1997, 20 patients underwent laparoscopic colectomy for Dukes A colon cancer. Operation time, blood loss, first passage of flatus, day of resumption of oral intake, length of hospital stay after surgery, and number of dissected lymph nodes were compared between 20 patients who underwent laparoscopic colectomy and 23 patients who underwent conventional open colectomy for Dukes A colon cancer. In patients with laparoscopic colectomy, when compared with those with conventional open colectomy, mean blood loss was less (103 g vs. 318 g), flatus returned more quickly (3.5 days vs. 4.2 days), oral intake resumed earlier (3.7 days vs. 4.7 days), and postoperative hospital stay was shorter (16.4 days vs. 24.6 days). The mean number of dissected lymph nodes was not different between the two groups (9.2 vs. 9.2 for D2 dissection). No patient had port-site metastasis or recurrence during a follow-up period from 13 to 60 months (median, 38 months). Review of the literature and the authors' findings indicated that none of the 142 reported patients had port-site metastasis after laparoscopic colectomy for Dukes A colon cancer. The results indicate that laparoscopic colectomy is safe and useful when applied to patients with Dukes A colon cancer and performed carefully by trained surgeons.
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22
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Yamagishi S, Watanabe T. Concomitant laparoscopic splenectomy and cholecystectomy for management of hereditary spherocytosis associated with gallstones. J Clin Gastroenterol 2000; 30:447. [PMID: 10875481 DOI: 10.1097/00004836-200006000-00022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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23
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Allardyce RA. Is the port site really at risk? Biology, mechanisms and prevention: a critical view. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:479-85. [PMID: 10442917 DOI: 10.1046/j.1440-1622.1999.01606.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Early case reports of port site tumour implants led to debate regarding the appropriateness of laparoscopic techniques for abdominal malignancies. Review of clinical, animal and cell culture studies addresses the relationships between tumour staging and shed cell behaviour that contributes to the peri-operative spread of tumours. In addition, a porcine model was used to test tumour cell distribution after laparoscopic and open colonic resections. Clinical evidence indicate that wound recurrence rates are 0.60 and 0.85% for open and laparoscopic colon cancer operations, respectively. Tumour staging and operative techniques are the most important factors determining wound implantation. Port site and open wounds are at equal risk of tumour implantation.
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Affiliation(s)
- R A Allardyce
- Department of Surgery, Christchurch School of Medicine, New Zealand.
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24
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Slim K, Pezet D, Chipponi J. [Endoscopic surgery of colorectal cancers: is it legitimate?]. CHIRURGIE; MEMOIRES DE L'ACADEMIE DE CHIRURGIE 1999; 124:77-86. [PMID: 10193037 DOI: 10.1016/s0001-4001(99)80047-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- K Slim
- Service de chirurgie générale et digestive, Hôtel-Dieu, Clermont-Ferrand, France
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25
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Abstract
BACKGROUND The recent development of laparoscopic techniques for fundoplication has created renewed interest in surgery for gastro-oesophageal reflux disease, leading to reports of large clinical series from many centres. However, controversy remains about technical aspects of laparoscopic antireflux surgery, with no consensus yet reached about a standard operative technique. It is important, therefore, to reassess critically the results of laparoscopic surgery for reflux disease, so that its current status can be determined. METHODS Published outcome studies for laparoscopic antireflux surgery, as well as selected studies from the era of open antireflux surgery, were reviewed to assess outcomes. RESULTS The results of case series for laparoscopic antireflux surgery with short- and medium-term follow-up, as well as the early results of randomized trials, confirm that this approach reduces the early overall morbidity of surgery for reflux disease. However, certain complications may be more common, for instance paraoesophageal hiatus herniation, pneumothorax and oesophageal perforation, requiring surgeons to use specific strategies which can help to avoid these problems. Published studies and trials do not support the routine or selective application of a posterior partial fundoplication technique or routine division of the short gastric vessels during Nissen fundoplication. CONCLUSION At present, a short loose Nissen fundoplication performed laparoscopically, with or without division of the short gastric vessels, is an appropriate surgical approach for gastro-oesophageal reflux disease. However, long-term outcomes following laparoscopic antireflux surgery will not be available for some years, and must be awaited before the final status of the various laparoscopic techniques can be confirmed.
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Affiliation(s)
- D I Watson
- University Department of Surgery, Royal Adelaide Hospital, South Australia, Australia
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26
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27
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Psaila J, Bulley SH, Ewings P, Sheffield JP, Kennedy RH. Outcome following laparoscopic resection for colorectal cancer. Br J Surg 1998; 85:662-4. [PMID: 9635817 DOI: 10.1046/j.1365-2168.1998.00634.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A prospective comparison of laparoscopic or laparoscopically assisted colorectal resection versus open resection has been undertaken to evaluate early benefits and cost implications. METHODS Consecutive patients with colorectal cancer underwent either elective laparoscopic (n = 25) or open (n = 29) resection. RESULTS Mean hospital stay was significantly shorter in the laparoscopic group: 10.7 versus 17.8 days. Mean morphine requirements were less in patients who had laparoscopic resection and their recovery, as measured by the dynamometer hand grip and the SF-36 symptom score, was more rapid. Adequate tumour clearance was achieved in the laparoscopic group. In both groups, the number of lymph nodes harvested was similar. Port-site or wound recurrence has not been observed at a median follow-up of 28 months. CONCLUSION When laparoscopic colorectal resection is possible, there are significant early benefits for patients.
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Affiliation(s)
- J Psaila
- Yeovil District Hospital, Higher Kingston, UK
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28
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El-sherif O. Surg Laparosc Endosc Percutan Tech 1998; 8:21-25. [DOI: 10.1097/00019509-199802000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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29
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Schwenk W, Böhm B, Junghans T, Hofmann H, Müller JM. Intermittent sequential compression of the lower limbs prevents venous stasis in laparoscopic and conventional colorectal surgery. Dis Colon Rectum 1997; 40:1056-62. [PMID: 9293935 DOI: 10.1007/bf02050929] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to evaluate the influence of intraoperative intermittent sequential compression (ISC) on venous blood return from the lower limbs during laparoscopic and conventional colorectal colectomy. METHODS Fifty patients undergoing laparoscopic (n = 25) or conventional (n = 25) colorectal surgery were included in a prospective study. Peak venous flow (PFV) and the cross-sectional area (CSA) of the femoral vein were assessed by Doppler ultrasound examination intraoperatively. RESULTS Age, gender, and body mass index were comparable between both groups. Baseline PFV was 21 +/- 6.6 cm/s in the conventional and 18.4 +/- 6.4 cm/s in the laparoscopic group (P = 0.2). ISC increased PFV to 156 +/- 29 percent of the baseline value in the conventional group and to 161 +/- 29 percent in the laparoscopic group. PFV decreased after abdominal insufflation to 127 +/- 19 percent of the baseline value in the laparoscopic group and after laparotomy to 134 +/- 27 percent in the conventional group (P = 0.3). PFV decreased slightly in both groups during surgery but remained well above the baseline value. Baseline CSA was 1.02 +/- 0.17 cm2 in the conventional group and 1 +/- 0.23 cm2 in the laparoscopic group. ISC decreased CSA to 0.91 +/- 0.18 cm2 (conventional) and 0.85 +/- 0.18 cm2 (laparoscopic) after initiation of ISC. CSA was 0.92 +/- 0.18 cm2 after abdominal insufflation in the laparoscopic group, and it was 0.93 +/- 0.18 cm2 after laparotomy in the conventional group (P = 0.4). During surgery, there were no differences in absolute CSA or CSA changes compared with the baseline value in both groups. Postoperative circumference of the calf and thigh were not different between both groups. Postoperative thromboembolic complications did not occur. CONCLUSION ISC effectively increases venous blood flow from the lower limbs during conventional and laparoscopic colorectal resections and may decrease the risk of postoperative deep vein thrombosis. Therefore, ISC is strongly recommended in every prolonged laparoscopic procedure.
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Affiliation(s)
- W Schwenk
- Department of General Surgery, Charité, Medical Faculty of the Humboldt-University, Berlin, Germany
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30
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Goh YC, Eu KW, Seow-Choen F. Early postoperative results of a prospective series of laparoscopic vs. Open anterior resections for rectosigmoid cancers. Dis Colon Rectum 1997; 40:776-80. [PMID: 9221851 DOI: 10.1007/bf02055431] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This study was undertaken to compare postoperatively laparoscopic (LAR) with open (OAR) anterior resection in patients with rectosigmoid cancers. METHODS Forty consecutive patients were divided into two groups: 20 patients (9 males) were allocated to LAR and 20 patients (6 males) to OAR. RESULTS Median age in the LAR group was 62 (range, 39-77) years, and in the OAR group, it was 61 (range, 43-84) years (P = 0.9). Median lengths of the distal margin of clearance beyond the tumor were 4 (range, 2-8) cm and 4.5 (range, 3-7.5) cm in the LAR and OAR groups, respectively (P = 0.35). Median numbers of lymph nodes harvested were 20 (range, 7-49) and 19 (range, 7-97) for the LAR and OAR groups, respectively (P = 0.44). Median operating times were 90 (range, 55-185) minutes and 73 (range, 40-140) minutes in the LAR and OAR groups, respectively (P = 0.08). Blood losses were 50 (range, 50-800) ml and 50 (range, 50-1,500) ml in the LAR and OAR groups, respectively. There was no intraoperative complication in either group, and no laparoscopic patient was converted to an open procedure. Median length of extraction site incision in the LAR group was 5.5 (4-13) cm, and length of incision in the OAR group was 18 (8-25) cm (P < 0.002). CONCLUSION There were no significant differences between the two groups with regard to duration of parenteral analgesia, starting of fluid and solid diet after surgery, or time to first bowel movement and time to discharge from the hospital.
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Affiliation(s)
- Y C Goh
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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31
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Affiliation(s)
- A Johnson
- Department of Surgical and Anaesthetic Sciences, University of Sheffield, Royal Hallamshire Hospital, UK
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32
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Stage JG, Schulze S, Møller P, Overgaard H, Andersen M, Rebsdorf-Pedersen VB, Nielseni HJ. Prospective randomized study of laparoscopicversus open colonic resection for adenocarcinoma. Br J Surg 1997. [DOI: 10.1002/bjs.1800840339] [Citation(s) in RCA: 186] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
Laparoscopic treatments for benign colonic disease and as palliative operations for advanced malignant disease have gained widespread acceptance as safe, efficacious, and beneficial treatment options. There are also strong indications that laparoscopic treatment for malignant colorectal disease is a viable alternative in selective patients. Further studies with substantial follow-up to determine the adequacy of resection and the comparability of cure rates are needed to assess any changes in the long-term staging and survival patterns of these treatments.
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Affiliation(s)
- P S Paik
- Division of Colorectal Surgery, University of Southern California, Los Angeles, USA
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Agachan F, Joo JS, Weiss EG, Wexner SD. Intraoperative laparoscopic complications. Are we getting better? Dis Colon Rectum 1996; 39:S14-9. [PMID: 8831541 DOI: 10.1007/bf02053800] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to assess various intraoperative and postoperative complications associated with laparoscopic colorectal surgery. Specifically, the impact of surgical experience and procedure type on complications was analyzed. METHODS All patients who underwent laparoscopic surgery were analyzed by age, sex, surgical indications, procedure performed, procedure length, intraoperative and postoperative complications, incidence and causes for conversion, duration of postoperative ileus, and length of hospital stay. Patients were classified for type of procedure and chronologically into four consecutive groups. Procedures were also categorized into four different groups: GI, total abdominal colectomies; GII, segmental resections; GIII, diverting procedures; GIV, others (abdominoperineal resection, Hartmann's creation or closure, anterior resection, and rectopexy). RESULTS Between August 1991 and October 1995, 167 patients of a mean age of 49.6 (15-88) years underwent laparoscopic colorectal procedures. All procedures were electively performed. Common indications for surgery included inflammatory disease in 70 (42 percent), neoplasia in 56 (33 percent), functional bowel disorders in 30 (18 percent), and other forms of colorectal disorders in 11 (7 percent) patients. The most significant variable affecting intraoperative laparoscopic complication rate was surgical experience measured as the time interval during which surgery was performed (P = 0.02). Total complication rate decreased from 29 percent during the first period to 11 percent by the second period (P < 0.04) and 7 percent during the third period (P < 0.005). Thus, the learning curve appeared to have required more than 50 cases to achieve. Moreover, even after performance of 94 (1991-1993) procedures in GI and GIV, these procedures were associated with higher complication rates than were those procedures in GII and GIII (P = 0.04). CONCLUSION Surgical experience and case selection are the most critical variables by which the surgeon can decrease the intraoperative laparoscopic complication rate.
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Affiliation(s)
- F Agachan
- Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA
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35
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Moore JW, Bokey EL, Newland RC, Chapuis PH. Lymphovascular clearance in laparoscopically assisted right hemicolectomy is similar to open surgery. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:605-7. [PMID: 8859160 DOI: 10.1111/j.1445-2197.1996.tb00829.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The application of laparoscopic techniques to malignant colorectal disease has led to concerns regarding the adequacy of excision achieved. This study was performed to compare specimen histopathology following laparoscopically assisted right hemicolectomy (LARHC) with that following open right hemicolectomy (ORHC). METHODS Data regarding patient details and tumour pathology were obtained by case-note review and from the Concord Hospital Colorectal Cancer Database. Thirty-two patients had LARHC for neoplastic lesions and 34 had ORHC for similar lesions over the same period. The two groups were well matched with respect to age, sex, weight and tumour characteristics. Early stage disease was more common in the LARHC group. RESULTS There was no clinically significant difference between the groups in terms of margins of clearance or number of lymph nodes harvested. CONCLUSIONS LARHC allows lymphovascular clearance indistinguishable from that afforded by open surgery. Long term outcome and survival data are required to confirm its role in the treatment of malignant colorectal disease.
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Affiliation(s)
- J W Moore
- Concord Repatriation General Hospital, New South Wales, Australia
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36
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Abstract
The circular stapling instrument has had a major impact in the practice of colorectal surgery. Stapling technology was pioneered in the early part of this century and subsequently modified. Russian initiatives led to development of the original circular stapling instrument and further progress has resulted in instruments that are widely available, reliable and totally disposable. Mechanical failure is now rare and malfunction is generally due to operator error. Complications related to the stapling technique are uncommon, although anastomotic stricture may be more frequent than when handsewn anastomosis is performed. A stapling instrument facilitates and may expedite a surgical procedure but it is an adjunct to, and not a substitute for, meticulous surgical technique.
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Affiliation(s)
- B J Moran
- Colorectal Research Unit, North Hampshire Hospital, Basingstoke, Hants, UK
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37
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Jess P, Moller EH, Ladefoged K, Christiansen J. Laparoscopic-assisted ileocecal resection for Crohn's disease: a preliminary study. Scand J Gastroenterol 1996; 31:302-4. [PMID: 8833362 DOI: 10.3109/00365529609004882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to present our preliminary results with laparoscopic-assisted ileocecal resection in Crohn's disease of the terminal ileum. METHODS Eight patients were operated on. The operations were assessed with regard to duration of operation, rate of conversion to open procedure, complications, time for discharge from hospital, and ability to take up work. RESULTS Median operation time was 145 min. One operation (12.5%) was converted to open procedure. Minor complications occurred in one patient (12.5%). Median postoperative time for discharge was 5 days. Median time to return to work was 21 days. CONCLUSIONS Laparoscopic-assisted ileocecal resection seems suited to Crohn's disease, but the benefit of the method needs confirmation in controlled, randomized studies.
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Affiliation(s)
- P Jess
- Dept. of Surgery and Medicine, Roskilde County Hospital, Koge, Denmark
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38
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Tanaka J, Ito M, Shindo Y, Kotanagi H, Koyama K. Laparoscopically assisted resection of the lower rectum. Surg Endosc 1996; 10:338-40. [PMID: 8779073 DOI: 10.1007/bf00187386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a new laparoscopic approach to the resection of the lower rectum which has been successfully used in the treatment of a patient with a small rectal carcinoid tumor. Under general anesthesia a pneumo-peritoneum was established with CO2 gas insufflation and the rectum was mobilized from the sacrum including division of the lateral ligaments under the direct view of the laparoscope. The bowel was divided between the sigmoid colon and the rectum using an endoscopic linear stapler, and the rectum was everted through the anal canal. The lower rectum was transected extracorporeally using a linear stapler and the rectal stump was then returned to the anatomical position. An anvil of a circular stapling device into the oral colon stump through a small skin incision on the left lower abdomen was introduced and the shaft of the device through the rectal stump via anus was inserted. The device was then re-approximated under laparoscopic view and fired. Our procedure described here is applicable to the lower rectal lesion as a minimally invasive, safe, and useful therapeutic tool.
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Affiliation(s)
- J Tanaka
- Department of Surgery, Akita University School of Medicine, Japan
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