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He Z, Ren J, Tang X, Li W, Zhang X, Liao W, Lin J, Wang J, Ao L, Xie J, Li H, Yi X, Lu X, Feng X, Diao D. Innovative pancreas-guided technique for splenic flexure mobilization in laparoscopic left hemicolectomy. Surg Endosc 2024:10.1007/s00464-024-11009-0. [PMID: 39060624 DOI: 10.1007/s00464-024-11009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/22/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE Splenic flexure mobilization (SFM) is a major challenge in laparoscopic left hemicolectomy. This study aims to assess the safety and effectiveness of the pancreas-guided SFM technique during laparoscopic left hemicolectomy. METHODS From January 2018 to December 2023, 352 patients with left-sided colon cancer underwent laparoscopic left hemicolectomy. Based on the SFM method used, the patients were divided into the pancreas-guided group (167 cases) or the "Three Approaches Roundabout"/classic group (185 cases). Clinicopathologic characteristics and intraoperative and postoperative variables were compared between the two groups. RESULTS The two groups had no significant differences in baseline indicators (P > 0.05). All surgeries were successful without needing to convert to laparotomy, and there were no combined organ resections involving the spleen or pancreas in either group. The mean duration of surgery was significantly lower in the pancreas-guided group than in the classic group (P < 0.01). The median volume of intraoperative blood loss in the pancreas-guided group was lower than that in the classic group (P < 0.01). Through video playback, it was found that the retro-pancreatic space had been entered during operation in 8 cases (4.3%) in the classic group, while there were no such occurrences in the pancreas-guided group. This difference was statistically significant (P < 0.05). The difference in the number of lymph nodes cleared, postoperative hospital stays, and incidence of complications were not statistically significant (all P > 0.05) between the groups. CONCLUSION The pancreas-guided SFM technique is a safe and feasible option for laparoscopic left hemicolectomy. Our study's findings suggest that this approach facilitates accurate access to the correct anatomic plane, potentially improving surgical efficiency.
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Affiliation(s)
- Ziyan He
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiaqi Ren
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Tang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenjuan Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xueyang Zhang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weilin Liao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jiaxin Lin
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jiahao Wang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lin Ao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jiaxin Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Hongming Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Xiaojiang Yi
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - XinQuan Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - XiaoChuang Feng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Dechang Diao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
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The effect of implant surgery experience on the learning curve of a dynamic navigation system: an in vitro study. BMC Oral Health 2023; 23:89. [PMID: 36782192 PMCID: PMC9926829 DOI: 10.1186/s12903-023-02792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Dynamic navigation systems have a broad application prospect in digital implanting field. This study aimed to explore and compare the dynamic navigation system learning curve of dentists with different implant surgery experience through dental models. METHODS The nine participants from the same hospital were divided equally into three groups. Group 1 (G1) and Group 2 (G2) were dentists who had more than 5 years of implant surgery experience. G1 also had more than 3 years of experience with dynamic navigation, while G2 had no experience with dynamic navigation. Group 3 (G3) consisted of dentists with no implant surgery experience and no experience with dynamic navigation. Each participant sequentially placed two implants (31 and 36) on dental models according to four practice courses (1-3, 4-6, 7-9, 10-12 exercises). Each dentist completed 1-3, 4-6 exercises in one day, and then 7-9 and 10-12 exercises 7 ± 1 days later. The preparation time, surgery time and related implant accuracy were analyzed. RESULTS Three groups placed 216 implants in four practice courses. The regressions for preparation time (F = 10.294, R2 = 0.284), coronal deviation (F = 4.117, R2 = 0.071), apical deviation (F = 13.016, R2 = 0.194) and axial deviation (F = 30.736, R2 = 0.363) were statistically significant in G2. The regressions for preparation time (F = 9.544, R2 = 0.269), surgery time (F = 45.032, R2 = 0.455), apical deviation (F = 4.295, R2 = 0.074) and axial deviation (F = 21.656, R2 = 0.286) were statistically significant in G3. Regarding preparation and surgery time, differences were found between G1 and G3, G2 and G3. Regarding implant accuracy, differences were found in the first two practice courses between G1 and G3. CONCLUSIONS The operation process of dynamic navigation system is relatively simple and easy to use. The linear regression analysis showed there is a dynamic navigation learning curve for dentists with or without implant experience and the learning curve of surgery time for dentists with implant experience fluctuates. However, dentists with implant experience learn more efficiently and have a shorter learning curve.
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Sun TM, Lee HE, Lan TH. The influence of dental experience on a dental implant navigation system. BMC Oral Health 2019; 19:222. [PMID: 31623636 PMCID: PMC6798373 DOI: 10.1186/s12903-019-0914-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluated the operating performance of an implant navigation system used by dental students and dentists of prosthodontic background with varying levels of experience. A surgical navigation system and optical tracking system were used, and dentists’ accuracies were evaluated in terms of differences between the positions of actually drilled holes and those of the holes planned using software before surgeries. Methods The study participants were 5 dental students or dentists who had studied in the same university and hospital but had different experience levels regarding implants. All participants were trained in operating the AqNavi system in the beginning of the study. Subsequently, using 5 pairs of dental models, each participant drilled 5 implant holes at 6 partially edentulous positions (11, 17, 26, 31, 36, and 47). In total, each participant conducted 30 drilling tests. Results In total, 150 tests among 5 dentists at 6 tooth positions (11, 17, 26, 31, 36, and 47) were conducted. Although a comparison of the tests revealed significant differences in the longitudinal error (P < .0001) and angular error (P = .0011), no significant difference was observed in the total error among the dentists. Conclusions A relatively long operating time was associated with relatively little implant experience. Through the dental navigation system, dental students can be introduced to dental implant surgery earlier than what was possible in the past. The results demonstrated that the operational accuracy of the dental implant navigation system is not restricted by participants’ implant experience levels. The implant navigation system assists the dentist in the ability to accurately insert the dental implant into the correct position without being affected by his/her own experience of implant surgery.
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Affiliation(s)
- Ting-Mao Sun
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan
| | - Huey-Er Lee
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan.,Division of Family Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ting-Hsun Lan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Sanmin District, Kaohsiung, 80708, Taiwan. .,Division of Prosthodontics, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Benlice C, Costedio M, Kessler H, Remzi FH, Gorgun E. Comparison of straight vs hand-assisted laparoscopic colectomy: an assessment from the NSQIP procedure-targeted cohort. Am J Surg 2016; 212:406-12. [PMID: 27083065 DOI: 10.1016/j.amjsurg.2016.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/09/2015] [Accepted: 01/03/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The perioperative outcomes of patients who underwent straight laparoscopic (LAP) vs hand-assisted laparoscopic (HALS) surgery were compared using a recently released procedure-targeted database. METHODS The 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database was used and patients were classified into 2 groups according to the final surgical approach: LAP vs HALS. Demographics, comorbidities, and 30-day outcomes were compared. RESULTS A total of 7,843 patients met the inclusion criteria. There were 4,656 (59%) patients in LAP colectomy and 3,187 (41%) in HALS colectomy groups. Groups were comparable in terms of preoperative characteristics and demographics. Mean operative time was slightly longer in LAP group (178 ± 86 vs 171 ± 84 minutes, P < .001). After covariate-adjustment analysis, the overall morbidity, superficial surgical site infection, and ileus rates remained slightly higher in HALS group. CONCLUSIONS Both straight laparoscopic and hand-assisted approaches are used in colorectal surgery and may complement each other in challenging cases. Implementing the best approach to decrease postoperative complication rates and increase use of minimally invasive techniques may play a role in improving patient care and overall quality.
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Affiliation(s)
- Cigdem Benlice
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Meagan Costedio
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Feza H Remzi
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Desk A-30, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Chen G, Liu Z, Han P, Li JW, Cui BB. The Learning Curve for the Laparoscopic Approach for Colorectal Cancer: A Single Institution's Experience. J Laparoendosc Adv Surg Tech A 2013; 23:17-21. [PMID: 23317439 DOI: 10.1089/lap.2011.0540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Gang Chen
- Department of Colorectal Surgery, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Zheng Liu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Han
- Department of Colorectal Surgery, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Jing-Wen Li
- Department of Colorectal Surgery, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Bin-Bin Cui
- Department of Colorectal Surgery, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
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Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection. Int J Colorectal Dis 2012; 27:1521-9. [PMID: 22622601 DOI: 10.1007/s00384-012-1495-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Laparoscopic resection of rectal cancer has already become the standard procedure in many hospitals. The splenic flexure mobilization (SFM) is an important preparational step. Several methods are used for laparoscopic SFM; however, studies comparing different approaches are lacking. In the present study, three different approaches for SFM have been compared to each other. METHODS Between January 1998 and December 2010, 415 patients with rectal adenocarcinoma underwent laparoscopic rectal resection at one center. Of these, 303 patients received complete splenic flexure mobilization. The SFM was performed using either a medial (SFM-M; n = 41), lateral (SFM-L; n = 214), or anterior (SFM-A; n = 48) approach. RESULTS There was a significantly higher rate of intraoperative complications in the SFM-L group as compared to the SFM-M or the SFM-A group (p = 0.038). Postoperative surgical complications occurred in 5 (10.6 %) patients of the SFM-A group compared to 38 patients (17.7 %) in the SFM-L group (p = 0.002) and 5 (12.1 %) patients in the SFM-M group (p = 0.037). SFM-L was also associated with a higher frequency of overall postoperative morbidity which was mainly due to wound infection rates (p = 0.001). CONCLUSIONS The anterior approach for SFM in laparoscopic surgery seems to be associated with lower frequency of intra- and postoperative morbidity.
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Kim HJ, Choi GS, Park JS, Park SY, Choi WH, Ryuk JP. Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:288-97. [PMID: 23166888 PMCID: PMC3491231 DOI: 10.4174/jkss.2012.83.5.288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/06/2012] [Accepted: 08/23/2012] [Indexed: 12/18/2022]
Abstract
Purpose We evaluated the short- and long-term outcomes of laparoscopic total proctocolectomy with ileal pouch-anal anastomosis (TPC/IPAA) for treatment of familial adenomatous polyposis (FAP). Also, we assessed the oncologic outcomes in FAP patients with coexisting malignancy. Methods From August 1999 to September 2010, 43 FAP patients with or without coexisting malignancy underwent TPC/IPAA by a laparoscopic-assisted or hand-assisted laparoscopic surgery. Results The median age was 33 years (range, 18 to 58 years) at the time of operation. IPAA was performed by a hand-sewn method in 21 patients (48.8%). The median operative time was 300 minutes (range, 135 to 610 minutes), which reached a plateau after 22 operations. Early postoperative complications within 30 days occurred in 7 patients (16.3%) and long-term morbidity occurred in 15 patients (34.9%) including 6 (14.0%) with desmoid tumors and 3 (7.0%) who required operative treatment. Twenty-two patients (51.2%) were diagnosed with coexisting colorectal malignancy. The median follow-up was 58.5 months (range, 7.9 to 97.8 months). There was only 1 case of local recurrence in the pelvic cavity. No cases of adenocarcinoma at the residual rectal mucosa developed. 5-year disease-free survival rate for 22 patients who had coexisting malignancy was 86.5% and 5-year overall survival rate was 92.6%. Three patients died from pulmonary or hepatic metastasis. Conclusion Laparoscopic TPC/IPAA in patients with FAP is feasible and offers favorable postoperative outcomes. It also delivered acceptable oncological outcomes in patients with coexisting malignancy. Therefore, laparoscopic TPC/IPAA may be a favorable treatment option for FAP.
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Affiliation(s)
- Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
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Abstract
Laparoscopic techniques have become increasingly used in the treatment of ulcerative colitis: in experienced hands, they are safe and feasible. Recovery advantages have not been consistently demonstrated and functional results have been comparable to open surgery. Other possible benefits and costs issues have also been inconsistent. Further investigation on the role of laparoscopic surgery for ulcerative colitis with larger populations and longer follow-up with a focus on recovery parameters, quality of life, and costs are needed.
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Affiliation(s)
- Luca Stocchi
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio. USA.
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Pellino G, Sciaudone G, Canonico S, Selvaggi F. Role of ileostomy in restorative proctocolectomy. World J Gastroenterol 2012; 18:1703-7. [PMID: 22553394 PMCID: PMC3332283 DOI: 10.3748/wjg.v18.i15.1703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 12/10/2011] [Accepted: 12/17/2011] [Indexed: 02/06/2023] Open
Abstract
Restorative proctocolectomy (RP) is the treatment of choice in patients affected with refractory ulcerative colitis or familial adenomatous polyposis. Surgery in elective settings is often performed in 2 stages, fashioning an ileostomy which is closed 2-3-mo later. It is still debated whether omitting ileostomy could offer advantages in the management of patients undergoing RP.
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Orcutt ST, Balentine CJ, Marshall CL, Robinson CN, Anaya DA, Artinyan A, Awad SS, Berger DH, Albo D. Use of a Pfannenstiel incision in minimally invasive colorectal cancer surgery is associated with a lower risk of wound complications. Tech Coloproctol 2012; 16:127-32. [DOI: 10.1007/s10151-012-0808-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 01/23/2012] [Indexed: 12/21/2022]
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Abarca F, Cologne KG, Francescatti A, Brand MI, Saclarides TJ. Incisionless Laparoscopic Total Proctocolectomy with Ileal J-Pouch Anal Anastomosis. Am Surg 2011. [DOI: 10.1177/000313481107700733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minimally invasive surgery continues to evolve. Recent innovations have included single-incision access, robotic technology, and natural orifice dissection and/or specimen extraction. Many argue that there is minimal patient benefit to these advanced techniques. We report 39 patients undergoing laparoscopic ileal J-pouch anal anastomosis surgery, 17 of whom did not have a separate specimen extraction incision (Group 1). The specimen for this group was extracted through the circular incision made for the ileostomy; the pouch was constructed extracorporeally and returned to the abdomen through the stoma site. For the remaining 22 patients, a suprapubic Pfannenstiel incision was made (Group 2). No hand-assistance was used for either group. Group 1 showed a 45-minute reduction in operative time, a 1-day reduction in hospital stay, and a reduction in complications. Although these differences are modest, it shows that minimally invasive surgery is an evolving process. Small modifications may translate into significant advantages.
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Affiliation(s)
- Francisco Abarca
- Section of Colon and Rectal Surgery, Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kyle G. Cologne
- Section of Colon and Rectal Surgery, Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Amanda Francescatti
- Section of Colon and Rectal Surgery, Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Marc I. Brand
- Section of Colon and Rectal Surgery, Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Theodore J. Saclarides
- Section of Colon and Rectal Surgery, Department of General Surgery, Rush University Medical Center, Chicago, Illinois
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Laparoscopic colectomy and restorative proctocolectomy for familial adenomatous polyposis. Surg Endosc 2010; 25:1866-75. [PMID: 21136106 DOI: 10.1007/s00464-010-1478-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 10/15/2010] [Indexed: 01/21/2023]
Abstract
BACKGROUND Familial adenomatous polyposis (FAP) is a dominantly inherited syndrome. Risk of cancer begins to increase after age 20 years if not treated. The purpose of this study was to evaluate the feasibility and short- and long-term outcomes after laparoscopic prophylactic surgery for FAP. METHODS Fifty-five patients with FAP were identified through the Hereditary Colorectal Tumor Registry from 2003 to 2009. Patients with laparoscopic total colectomy (TC)/IRA or proctocolectomy (TPC)/ileal pouch-anal anastomosis IPAA were included. Patients with previous colon or abdominal major surgery, malignancy, and desmoids before surgery were excluded. Main outcomes were: 30 days anastomotic leak and pouch failure; long-term desmoids and malignant recurrence. RESULTS Of the 55 patients, 32 were men, median age was 28 years, and mean body mass index was 23. Median follow-up time was 36 (range, 5-77) months. Forty-four patients had laparoscopic TC/IRA and ten had laparoscopic TPC/IPAA. One patient was converted to open surgery and received an open TPC/IPAA. Incision length was 7 (range, 5-14) cm. Anastomotic leak was 3 (5.4%: 2 laparoscopic and 1 open), and pouch failure was 0. Median postsurgical length of stay was 7 (range, 4-24) days. Desmoids occurred in three patients (5.4%), and there was no malignant recurrence within the follow-up period. Pathology revealed severe dysplasia in ten patients and adenocarcinoma in nine (8 laparoscopic and 1 open). Long-term small-bowel obstruction was 2 (3.6%). One mortality due to liver metastases occurred at 24 months. CONCLUSIONS Laparoscopic prophylactic treatment of FAP appears to be safe and feasible and may be an appealing alternative to open surgery. If the goal of prophylactic FAP surgery is to avoid cancer occurrence, laparoscopic surgery could be an important advancement.
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Ozawa H, Kokuba Y, Nakamura T, Naito M, Sato T, Hatate K, Onozato W, Miura H, Tsutsui A, Ikeda A, Ihara A, Watanabe M. Minimally invasive straight laparoscopic total proctocolectomy for ulcerative colitis. Asian J Endosc Surg 2010. [DOI: 10.1111/j.1758-5910.2009.00026.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: 11/28/2022]
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Pattana-arun J, Sahakitrungruang C, Atithansakul P, Tantiphlachiva K, Khomvilai S, Rojanasakul A. Multimedia article. Hand-assisted laparoscopic total mesorectal excision: a stepwise approach. Dis Colon Rectum 2009; 52:1787. [PMID: 19966615 DOI: 10.1007/dcr.0b013e3181b618d5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J Pattana-arun
- Colorectal Surgery, Chulalongkorn University, Bangkok, Thailand.
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Holubar SD, Larson DW, Dozois EJ, Pattana-Arun J, Pemberton JH, Cima RR. Minimally invasive subtotal colectomy and ileal pouch-anal anastomosis for fulminant ulcerative colitis: a reasonable approach? Dis Colon Rectum 2009; 52:187-92. [PMID: 19279410 DOI: 10.1007/dcr.0b013e31819a5cc1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE This study was designed to evaluate the safety, feasibility, and short-term outcomes of three-stage minimally invasive surgery for fulminant ulcerative colitis. METHODS Using a prospective database, we identified all patients with ulcerative colitis who underwent minimally invasive surgery for both subtotal colectomy and subsequent ileal pouch-anal anastomosis at our institution from 2000 to 2007. Demographics and short-term outcomes were retrospectively evaluated. RESULTS During seven years, 50 patients underwent minimally invasive subtotal colectomy for fulminant ulcerative colitis; 50 percent were male, with a median age of 34 years. All patients had refractory colitis: 96 percent were taking steroids, 76 percent were recently hospitalized, 59 percent had >/=5 kg weight loss, 57 percent had anemia that required transfusions, 30 percent were on biologic-based therapy, and 96 percent had >/=1 severe Truelove & Witts' criteria. Of these 50 procedures, 72 percent were performed by using laparoscopic-assisted and 28 percent with hand-assisted techniques. The conversion rate was 6 percent. Subsequently, minimally invasive completion proctectomy with ileal pouch-anal anastomosis was performed in 42 patients with a 2.3 percent conversion rate. Median length of stay after each procedure was four days. There was one anastomotic leak and no mortality. CONCLUSIONS A staged, minimally invasive approach for patients with fulminant ulcerative colitis is technically feasible, safe, and reasonable operative strategy, which yields short postoperative length of stay.
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Affiliation(s)
- Stefan D Holubar
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Laparoscopic restorative proctocolectomy with ileal S-pouch. Dis Colon Rectum 2008; 51:1790-4. [PMID: 18607550 DOI: 10.1007/s10350-008-9408-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 04/01/2008] [Accepted: 04/19/2008] [Indexed: 02/08/2023]
Abstract
PURPOSE Restorative proctocolectomy has revolutionized the surgical management of ulcerative colitis and familial polyposis syndromes. Though now evolved to include laparoscopy, this approach has not included alternative pouch designs such as ileal S-pouch reconstruction. This comparative analysis evaluated the combination of laparoscopic-assisted total proctocolectomy with an ileal S-pouch design. METHODS One hundred fifty-six (65 laparoscopic-assisted) total proctocolectomy and ileal S-pouch-anal anastomosis procedures performed between 2003 to 2007 were identified from a prospective surgical database. Operative time, length of incision, length of hospital stay, complications, and return of bowel function were examined. A cost analysis including preoperative through postoperative hospital stay and operating room and postanesthesia care unit costs was performed. RESULTS The laparoscopic-assisted total proctocolectomy and ileal S-pouch-anal anastomosis procedures were performed for ulcerative colitis in 60 cases and familial adenomatous polyposis in the remaining 5 patients. Four conversions to open technique occurred (6 percent). Comparing laparoscopic and open procedures, the laparoscopic approach took longer to perform than the open technique (mean 451 minutes vs. 347 minutes open; P < 0.001). The mean hospital stay was 6.3 days in the laparoscopic group vs. 8.2 days in the open group (P < 0.001). A detailed cost analysis revealed similar overall costs between the laparoscopic ($18,700) and open approaches ($18,500). CONCLUSION Use of a laparoscopic total proctocolectomy with ileal S-pouch-anal anastomosis reconstruction minimizes incision size and shortens hospital stay. At a teaching academic institution, the laparoscopic approach requires longer operative times yet a negligible cost disadvantage.
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