Single-Site Laparoscopic Colorectal Surgery Provides Similar Clinical Outcomes Compared With Standard Laparoscopic Surgery

Introduction. Hand-assisted laparoscopic surgery (HALS) was introduced into clinical practice in the mid-1990s. Although this technique was established as a bridge to total laparoscopic colorectal surgery there are still those who oppose it. In this study we report our 10 year experience of practicing HALS. Methods. This study is a retrospective analysis of prospectively collected data of 426 patients undergoing hand-assisted laparoscopic colorectal surgery for left-sided colon and rectal cancer in a single tertiary care institution, the National Cancer Institute, from January, 2006, to July, 2016. All consenting patients with left sided colon and rectal cancer were included in the analysis. Results. Patient population showed a similar female and male ratio 212 (49.76%) vs. 214 (50.24%). Average age was 64.13 ? 9.92 years (from 26 to 91). Operation time was 108 minutes ? 44.1 min (30 - 320 min). The mean length of the postoperative hospital stay was 6.88, ranging from 2 to 34 days. The pathohistological examination revealed mean lymph node harvest was 16.4 ? 9.61, ranging from 0 to 54. Stage I and II cancer prevailed in the majority of cases, accounting for 129 (30.28%) for each, stage III - 135 (31.69%), and stage IV - 33 (7.74%). Complication rate was 7.27%. Surgical reintervention was required in 10 cases (2.35%). Mortality rate occurred only in two (0.47%) patients. Conclusion. In conclusion, the HALS technique combines the benefits of a minimal invasive technique for the patient and palpatory benefits for the surgeon, which makes surgery for left-sided colon and rectum cancer faster, and with a similar outcome to laparoscopic colectomy.

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The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

Digestive Surgery ◽

10.1159/000511180 ◽

2020 ◽

pp. 1-8

Author(s):

Martijn Maassen van den Brink ◽

Thaís T.T. Tweed ◽

Patrick A. de Hoogt ◽

A.G.M. Hoofwijk ◽

Karel W.E. Hulsewé ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Operating Time ◽

Median Hospital Stay ◽

Total Cost ◽

Hospital Economics ◽

Financial Benefits ◽

Clinical Benefits ◽

Improve Hospital

Introduction: Clinical benefits of laparoscopic surgery are well established, but evidence for financial benefits is limited. This study aimed to compare the financial impact of the introduction of laparoscopic colorectal surgery. Methods: This study included patients who underwent colorectal surgery between January 2010 and 2015. We collected a range of financial data and divided the patients into 2 groups. Primary outcome was total cost defined by surgical-related costs. Results: A total of 1,246 patients were included, of which 440 surgeries were performed laparoscopically. The total median cost of laparoscopy was higher compared to open surgery (EUR 4,665 vs. EUR 4,268, p = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, p < 0.001), longer operating time (3.2 vs. 2.5 hours, p < 0.001), and more readmissions (10.9 vs. 8.5%, p < 0.001). However, after adjusting for heterogeneity, no difference was found in total cost. Surgical-related costs were counterbalanced by lower costs associated with shorter median hospital stay (6 vs. 9 days, p < 0.001), less morbidity (37.3 vs. 55.1%, p < 0.001), and less mortality (1.8 vs. 5.6%, p = 0.013) for laparoscopy. Conclusion: During the introduction of laparoscopy for colorectal surgery, no significant differences were found in total cost between laparoscopic and open colorectal surgery. However, favorable postoperative outcomes were achieved with laparoscopic surgery.

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Persistent Descending Mesocolon as a Risk Factor of Laparoscopic Surgery for Colorectal Cancer: A Single Institution Experience

International Surgery ◽

10.9738/intsurg-d-16-00085.1 ◽

2019 ◽

Vol 104 (9-10) ◽

pp. 439-445

Author(s):

Hidekazu Takahashi ◽

Nobuo Tanaka ◽

Osamu Takayama ◽

Masashi Baba ◽

Masaru Murata ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Three Dimensional ◽

Tumor Location ◽

Computed Tomographic ◽

Preoperative Diagnostic ◽

Tomographic Slice

The objectives of this study are to clarify the significance of persistent descending mesocolon (PDM), a kind of intestinal malrotation, in laparoscopic colorectal surgery and present potentially useful preoperative diagnostic methods for PDM. Although several risk factors for laparoscopic colorectal surgery have been convincingly reported, the impact of PDM on laparoscopic surgery for colorectal cancer remains less studied. This was an observational study with a retrospective analysis. A consecutive 110 patients undergoing laparoscopic colorectal surgery for colorectal cancer were included. To identify risk factors for operative time of laparoscopic surgery for colorectal cancer, we examined age, sex, body mass index, American Society of Anesthesiologists Performance Status score, tumor location, depth of tumor invasion, lymph node metastasis, and PDM as potential risk factors. For identification of appropriate preoperative diagnostic imaging, we reviewed three-dimensional vessel images reconstructed from computed tomographic slice data of all patients. During the study period, no effective pre- or intraoperative diagnoses of PDM were achieved. A total of 4 patients were diagnosed with PDM. Sex (P = 0.0032); tumor location (P = 0.0044); lymph node metastasis (P = 0.022); and PDM (P = 0.0007) were identified as risk factors based on multivariate analysis. A ventrally branched left colic artery visualized by three-dimensional imaging appeared to be a highly specific feature of PDM. Laparoscopic surgery for colorectal cancer with PDM was difficult without the recognition of PDM. PDM was well-defined preoperatively using three-dimensional vessels images reconstructed from computed tomographic slice data.

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The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery

Innovative Surgical Sciences ◽

10.1515/iss-2017-0048 ◽

2018 ◽

Vol 3 (1) ◽

pp. 77-84

Author(s):

Bernd Schneider ◽

Anne Catharina Brockhaus ◽

Marcos Gelos ◽

Claudia Rudroff

Keyword(s):

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Hospital Stay ◽

Single Incision ◽

Laparoscopic Colorectal Surgery ◽

Postoperative Hospital Stay ◽

Colorectal Disease ◽

Single Incision Laparoscopic Surgery ◽

Surgery Technique ◽

Significant Difference

AbstractBackground:Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients.Methods:Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given.Results:There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS.Conclusion:SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.

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Two-Arm Robotic-Assisted High Anterior Resection: a Cost-Effective Way to Perform Robotic Surgery

Indian Journal of Surgery ◽

10.1007/s12262-021-02864-5 ◽

2021 ◽

Author(s):

Vivek Sharma ◽

Thusitha Hettiarachchi ◽

Dhiraj Sharma ◽

Irshad Shaikh

Keyword(s):

Laparoscopic Surgery ◽

Robotic Surgery ◽

Colorectal Surgery ◽

Anterior Resection ◽

Cost Effective ◽

Robotic Assisted ◽

Novel Method ◽

Standard Laparoscopic Surgery ◽

The Cost ◽

Disposable Equipment

AbstractIn the era where laparoscopic colorectal surgery is well established, robotic- assisted colorectal surgery is gaining increasing popularity and acceptability. Stable camera platform, superior 3D views, and articulating instruments help to overcome difficulties associated with standard laparoscopic surgery. However, a significant drawback of robotic surgery is the cost of the robotic system and relevant disposable equipment compared to conventional laparoscopic surgery. This image series depicts a novel method to perform laparoscopic high anterior resection in a more cost-effective way.

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