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Colombari R, Pérez-Carpio C, Sánchez Rodríguez M, Martínez J, Dujovne P, Zorrilla J, Jiménez-Gómez LM, Tejedor P. Preoperative Planning of D3 Right Colectomy With 3-Dimensional Vascular Reconstruction. Dis Colon Rectum 2024; 67:e1446-e1447. [PMID: 38354023 DOI: 10.1097/dcr.0000000000003119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Affiliation(s)
- Renan Colombari
- Colorectal Surgery Unit, University Hospital Gregorio Maranon, Madrid, Spain
| | | | | | - Javier Martínez
- Radiology Department, University Hospital Gregorio Maranon, Madrid, Spain
| | - Paula Dujovne
- Colorectal Surgery Unit, University Hospital Gregorio Maranon, Madrid, Spain
| | - Jaime Zorrilla
- Colorectal Surgery Unit, University Hospital Gregorio Maranon, Madrid, Spain
| | | | - Patricia Tejedor
- Colorectal Surgery Unit, University Hospital Gregorio Maranon, Madrid, Spain
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Bracale U, Iacone B, Tedesco A, Gargiulo A, Di Nuzzo MM, Sannino D, Tramontano S, Corcione F. The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review. Cir Esp 2024; 102 Suppl 1:S36-S44. [PMID: 38307256 DOI: 10.1016/j.cireng.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
New advanced technologies have recently been developed and preliminarily applied to surgery, including virtual reality (VR), augmented reality (AR) and mixed reality (MR). We retrospectively review all colorectal cases in which we used holographic 3D reconstruction from February 2020 to December 2022. This innovative approach was used to identify vascular anomalies, pinpoint tumor locations, evaluate infiltration into neighboring organs and devise surgical plans for both training and educating trainee assistants. We have also provided a state-of-the-art analysis, briefly highlighting what has been stated by the scientific literature to date. VR facilitates training and anatomical assessments, while AR enhances training and laparoscopic performance evaluations. MR, powered by HoloLens, enriches anatomic recognition, navigation, and visualization. Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application. This technology holds significant promise for advancing colorectal surgery by elevating safety and reliability standards.
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Affiliation(s)
- Umberto Bracale
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Biancamaria Iacone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy.
| | - Anna Tedesco
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Antonio Gargiulo
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | | | - Daniele Sannino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
| | - Salvatore Tramontano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy
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Wang Y, Liu ZS, Wang ZB, Liu S, Sun FB. Efficacy of laparoscopic low anterior resection for colorectal cancer patients with 3D-vascular reconstruction for left coronary artery preservation. World J Gastrointest Surg 2024; 16:1548-1557. [PMID: 38983331 PMCID: PMC11230005 DOI: 10.4240/wjgs.v16.i6.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Laparoscopic low anterior resection (LLAR) has become a mainstream surgical method for the treatment of colorectal cancer, which has shown many advantages in the aspects of surgical trauma and postoperative rehabilitation. However, the effect of surgery on patients' left coronary artery and its vascular reconstruction have not been deeply discussed. With the development of medical imaging technology, 3D vascular reconstruction has become an effective means to evaluate the curative effect of surgery. AIM To investigate the clinical value of preoperative 3D vascular reconstruction in LLAR of rectal cancer with the left colic artery (LCA) preserved. METHODS A retrospective cohort study was performed to analyze the clinical data of 146 patients who underwent LLAR for rectal cancer with LCA preservation from January to December 2023 in our hospital. All patients underwent LLAR of rectal cancer with the LCA preserved, and the intraoperative and postoperative data were complete. The patients were divided into a reconstruction group (72 patients) and a nonreconstruction group (74 patients) according to whether 3D vascular reconstruction was performed before surgery. The clinical features, operation conditions, complications, pathological results and postoperative recovery of the two groups were collected and compared. RESULTS A total of 146 patients with rectal cancer were included in the study, including 72 patients in the reconstruction group and 74 patients in the nonreconstruction group. There were 47 males and 25 females in the reconstruction group, aged (59.75 ± 6.2) years, with a body mass index (BMI) (24.1 ± 2.2) kg/m2, and 51 males and 23 females in the nonreconstruction group, aged (58.77 ± 6.1) years, with a BMI (23.6 ± 2.7) kg/m2. There was no significant difference in the baseline data between the two groups (P > 0.05). In the submesenteric artery reconstruction group, 35 patients were type I, 25 patients were type II, 11 patients were type III, and 1 patient was type IV. There were 37 type I patients, 24 type II patients, 12 type III patients, and 1 type IV patient in the nonreconstruction group. There was no significant difference in arterial typing between the two groups (P > 0.05). The operation time of the reconstruction group was 162.2 ± 10.8 min, and that of the nonreconstruction group was 197.9 ± 19.1 min. Compared with that of the reconstruction group, the operation time of the two groups was shorter, and the difference was statistically significant (t = 13.840, P < 0.05). The amount of intraoperative blood loss was 30.4 ± 20.0 mL in the reconstruction group and 61.2 ± 26.4 mL in the nonreconstruction group. The amount of blood loss in the reconstruction group was less than that in the control group, and the difference was statistically significant (t = -7.930, P < 0.05). The rates of anastomotic leakage (1.4% vs 1.4%, P = 0.984), anastomotic hemorrhage (2.8% vs 4.1%, P = 0.672), and postoperative hospital stay (6.8 ± 0.7 d vs 7.0 ± 0.7 d, P = 0.141) were not significantly different between the two groups. CONCLUSION Preoperative 3D vascular reconstruction technology can shorten the operation time and reduce the amount of intraoperative blood loss. Preoperative 3D vascular reconstruction is recommended to provide an intraoperative reference for laparoscopic low anterior resection with LCA preservation.
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Affiliation(s)
- Ye Wang
- Department of General Surgery, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao 266033, Shandong Province, China
| | - Zhi-Sheng Liu
- Department of General Surgery, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao 266033, Shandong Province, China
| | - Zong-Bao Wang
- Department of General Surgery, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao 266033, Shandong Province, China
| | - Shawn Liu
- Department of Gastrointestinal Surgery, National University Hospital of Singapore, Singapore 119228, Singapore
| | - Feng-Bo Sun
- Department of General Surgery, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao 266033, Shandong Province, China
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Anania G, Campagnaro A, Chiozza M, Randolph J, Resta G, Marino S, Pedon S, Agrusa A, Cuccurullo D, Cirocchi R. A SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) observational prospective multicenter study on anatomical variants of the superior mesenteric artery: intraoperative analysis during laparoscopic right hemicolectomy-CoDIG 2 database (ColonDx Italian Group). Updates Surg 2024; 76:933-941. [PMID: 38526696 PMCID: PMC11129964 DOI: 10.1007/s13304-024-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
Colorectal cancer, the third most common cancer worldwide, affects 40-45% of patients on the right side. Surgery, especially minimally invasive methods such as laparoscopic and robotic procedures, is the preferred treatment. However, these techniques present technical complications. The anatomical complexity and variations in vessel branching patterns pose challenges, particularly for less experienced surgeons. The CoDIG 2 is a nationwide observational study involving 76 specialized Italian general surgery departments focused on colorectal surgery. The centres were directed to maintain their standard surgical and clinical practices. The aim of this study was to analyse the intraoperative vascular anatomy of Italian patients who underwent laparoscopic right colectomy and explore the ligature techniques used by Italian surgeons. Surgeons reported information about vascularization of the right colon for 616 patients and about surgical anatomy of RCA for 368 patients. Fifty-three patients (10.8%) showed no RCA intraoperatively. The right colic artery (RCA) was categorized according to the Yada classification (types 1-4) during evaluation, and intraoperative assessments revealed that Yada type 1 was the most common type (55.2%), while radiologic evaluations revealed a higher prevalence of type 2. Furthermore, compared with the superior mesenteric vein (SMV), the RCA is more often located anteriorly according to intraoperative and contrast-enhanced CT examination; 59.9% were found in the anterior position during intraoperative examination, while 40.1% were found in the same position on preoperative contrast-enhanced CT. Vascularization of the right colon, including missing branches, additional branches, shared trunks, and retro-superior courses of the mesenteric vein, exhibited notable variations. To understand vascular variations, a preoperative radiological study is necessary; although there was no concordance between the intraoperative and radiological evaluations, this is a limitation of preinterventional radiological evaluation (PII) because it is always needed for oncological staging. This approach is especially critical for inexperienced surgeons to avoid potential complications, such as problematic bleeding.
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Affiliation(s)
- G Anania
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Campagnaro
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy.
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy.
| | - M Chiozza
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - J Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, 30341, USA
| | - G Resta
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Marino
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
| | - S Pedon
- Unit of General Surgery, S. Anna University Hospital of Ferrara, Via Aldo Moro 8, Cona, FE, Italy
- Department of Medical Science, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, FE, Italy
| | - A Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, PA, Italy
| | - D Cuccurullo
- Division of Laparoscopic and Robotic Surgery Unit, A.O.R.N. Colli Monaldi Hospital, Napoli, NA, Italy
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, PG, Italy
- Division of Digestive and Emergency Surgery, Santa Maria Hospital, Via Tristano di Joannuccio 05100, Terni, TR, Italy
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Pal A, Chittleborough T, McCombie A, Glyn T, Frizelle FA. Human factors in pelvic exenteration: themes in high-performing teams. Colorectal Dis 2024; 26:95-101. [PMID: 38057630 DOI: 10.1111/codi.16825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/26/2023] [Accepted: 10/02/2023] [Indexed: 12/08/2023]
Abstract
AIM The aim of this study was to investigate the role of human factors in pelvic exenteration and how team performance is optimized in the preoperative, intraoperative and postoperative phases. METHOD Qualitative analysis of focus groups was used to capture authentic human interactions that reflect real-world multiprofessional performance. Theatre teams were treated as clusters, with a particular focus group containing participants who worked together regularly. RESULTS Three focus groups were conducted. Four themes emerged - driving force, technical skills, nontechnical skills and operational aspects - with a total of 16 subthemes. Saturation was reached by group 2, with no new subthemes emerging after this. There was some interaction between the themes and the subthemes. Broadly speaking, driving force led to the development of specialised technical skills and nontechnical skills, which were operationalized into successful service through operational aspects. CONCLUSION This study of teams performing pelvic exenteration is the first in the field using this methodology. It has generated rich qualitative data with authentic insights into the pragmatic aspects of developing and delivering a service. In addition, it shows how the themes are connected or 'coupled' in a network, for example technical and non-technical skills. In a complex system, 'tight coupling' leads to both high performance and adverse events. In this paper, we report the qualitative aspects of high performance by pelvic exenteration teams in a complex sociotechnical system, which depends on tight coupling of several themes.
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Affiliation(s)
- A Pal
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - A McCombie
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - T Glyn
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - F A Frizelle
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
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Moynihan A, Khan MF, Cahill RA. Intra-operative in-line holographic display of patient-specific anatomy via a three-dimensional virtual model during laparoscopic right hemicolectomy for colon cancer: Video correspondence - A video vignette. Colorectal Dis 2023; 25:2122-2123. [PMID: 37705193 DOI: 10.1111/codi.16744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Alice Moynihan
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | | | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Ireland
- Department of Surgery, Mater Misericordiae university Hospital, Dublin, Ireland
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Benz SR, Feder IS, Vollmer S, Tam Y, Reinacher-Schick A, Denz R, Hohenberger W, Lippert H, Tannapfel A, Stricker I. Complete mesocolic excision for right colonic cancer: prospective multicentre study. Br J Surg 2022; 110:98-105. [PMID: 36369986 PMCID: PMC10364501 DOI: 10.1093/bjs/znac379] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/24/2022] [Accepted: 10/21/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) for right colonic cancer is a more complex operation than standard right hemicolectomy but evidence to support its routine use is still limited. This prospective multicentre study evaluated the effect of CME on long-term survival in colorectal cancer centres in Germany (RESECTAT trial). The primary hypothesis was that 5-year disease-free survival would be higher after CME than non-CME surgery. A secondary hypothesis was that there would be improved survival of patients with a mesenteric area greater than 15 000 mm2. METHODS Centres were asked to continue their current surgical practices. The surgery was classified as CME if the superior mesenteric vein was dissected; otherwise it was assumed that no CME had been performed. All specimens were shipped to one institution for pathological analysis and documentation. Clinical data were recorded in an established registry for quality assurance. The primary endpoint was 5-year overall survival for stages I-III. Multivariable adjustment for group allocation was planned. Using a primary hypothesis of an increase in disease-free survival from 60 to 70 per cent, a sample size of 662 patients was calculated with a 50 per cent anticipated drop-out rate. RESULTS A total of 1004 patients from 53 centres were recruited for the final analysis (496 CME, 508 no CME). Most operations (88.4 per cent) were done by an open approach. Anastomotic leak occurred in 3.4 per cent in the CME and 1.8 per cent in the non-CME group. There were slightly more lymph nodes found in CME than non-CME specimens (mean 55.6 and 50.4 respectively). Positive central mesenteric nodes were detected more in non-CME than CME specimens (5.9 versus 4.0 per cent). One-fifth of patients had died at the time of study with recorded recurrences (63, 6.3 per cent), too few to calculate disease-free survival (the original primary outcome), so overall survival (not disease-specific) results are presented. Short-term and overall survival were similar in the CME and non-CME groups. Adjusted Cox regression indicated a possible benefit for overall survival with CME in stage III disease (HR 0.52, 95 per cent c.i. 0.31 to 0.85; P = 0.010) but less so for disease-free survival (HR 0.66; P = 0.068). The secondary outcome (15 000 mm2 mesenteric size) did not influence survival at any stage (removal of more mesentery did not alter survival). CONCLUSION No general benefit of CME could be established. The observation of better overall survival in stage III on unplanned exploratory analysis is of uncertain significance.
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Affiliation(s)
- Stefan R Benz
- Klinik für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie Kliniken Boeblingen, Boeblingen, Germany
| | - Inke S Feder
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Saskia Vollmer
- Klinik für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie Kliniken Boeblingen, Boeblingen, Germany
| | - Yu Tam
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Anke Reinacher-Schick
- Hämatologie und Onkologie mit Palliativmedizin, Ruhruniversität Bochum, Bochum, Germany
| | - Robin Denz
- Abteilung für medizinische Informatik, Biometrie und Epidemiologie der Rur-Universität Bochum, Bochum, Germany
| | | | - Hans Lippert
- AN-Institut für Qualitätssicherung in der operativen Medizin, Magdeburg, Germany
| | - Andrea Tannapfel
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
| | - Ingo Stricker
- Institut für Pathologie der Ruhr-Universität Bochum, Bochum, Germany
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