scholarly journals Case Report: Early Recognition and Repair of Distal Iatrogenic Ureteral Injury During Laparoscopic Rectal Surgery

2021 ◽  
Vol 2 (2) ◽  
pp. 73-76
Author(s):  
Abdul Mughni ◽  
Ahmad Fathi Fuadi ◽  
Nanda Daniswara
Keyword(s):  
Rectal Cancer ◽  
Colorectal Surgery ◽  
Early Recognition ◽  
Rectal Surgery ◽  
Laparoscopic Approach ◽  
Ureteral Injury ◽  
Uneventful Recovery ◽  
Rectal Cancer Surgery ◽  
Distal Ureter ◽  
Iatrogenic Ureteral Injury

Background: Ureteral injury is an uncommon complication of the colorectal procedure. The colorectal procedure is the second most common cause of ureteral injury. The laparoscopic approach for colorectal surgery has contributed to the increase of ureteral injury. Delayed diagnosis of the iatrogenic ureteral injury is associated with higher morbidity. However, the early diagnosis of ureteral injury during the operation is difficult. We presented an early recognition and laparoscopic repair of iatrogenic ureteral injury during laparoscopic rectal cancer surgery cases and the strategy for recognizing and managing that injury for the surgeon.Case Presentation: A Male, 34 years old, had an iatrogenic ureteral injury during laparoscopic low anterior resection for rectal cancer. The left distal ureter was transected by an energy device. The diagnosis of ureteral injury was prompt. The repair of the ureter was done endo-laparoscopically. The patient had an uneventful recovery and was discharged on day 6 after surgery.Conclusion: The iatrogenic ureteral injury, although uncommon, is a serious complication of laparoscopic colorectal surgery. Direct visual identification of the distal ureter is mandatory in every rectal surgery. The iatrogenic ureteral injury is not an indication for open conversion when there is an adequate resource to do the endo-laparoscopic ureteral repair.

scholarly journals Parameters of radical resection in laparoscopic and open colon and rectal cancer surgery

2020 ◽  
Vol 77 (5) ◽  
pp. 532-538
Author(s):  
Igor Krdzic ◽  
Marko Kenic ◽  
Milena Scepanovic ◽  
Ivan Soldatovic ◽  
Jelena Ilic-Zivojinovic ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Lymph Nodes ◽  
Open Surgery ◽  
Rectal Surgery ◽  
Laparoscopic Approach ◽  
Resection Margins ◽  
Rectal Cancer Surgery ◽  
Open Approach ◽  
Colon And Rectal Cancer

Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumferential, proximal and distal resection margins are without the presence of tumor cells. Concept of total mesorectal excision in rectal surgery involves complete removal of the tumor with mesorectal fascia which surrounds lymph nodes, lymphatics and blood vessels. The aim of this study was to determine whether laparoscopic approach provides all parameters of oncological radicality as open surgery of colorectal cancer. Methods. The study included 122 patients with carcinoma of colon and rectum, divided into two equal groups: patients operated on by laparoscopic and those operated on by open approach. In colon surgery we analyzed proximal and distal resection margins, and the number of removed lymph nodes, and in rectal surgery: proximal, distal and circumferential resection margins, and the number of removed lymph nodes. Results. Both groups were comparable in age, sex, American Society of Anesthesiologists (ASA) score, tumor localization, tumor size, and type of surgical operation performed. According to localization of the tumor, the most commonly performed operation was anterior resection of the rectum (60.7% vs. 59%). There was no case of the tumor involvement of the distal margin. Average proximal distance from the tumor on the fixed specimen was 100 vs. 120 mm with statistical significance (p < 0.001). Distal margins were not significantly different, 40 mm in both groups (p = 0.143). In two cases we had circumferential resection margin (CRM) of 1 mm (7.7%) in the laparoscopic group, and in three cases operated conventionally CRM was 1 mm (8.8%). The average number of removed lymph nodes was 15 vs. 16, respectively. Length of hospital stay for patients assigned to the laparoscopic surgery was significantly shorter than for patients operated on by the open approach. Concerning postoperative complications, no significant difference was found between groups. The overall postoperative morbidity was 18% vs. 21.3%, respectively. Conclusion. With laparoscopic approach it is possible to provide all parameters of oncological radicality similarly to the open surgery of colorectal cancer.

scholarly journals Robotic colorectal surgery: more than a fantastic toy?

2018 ◽  
Vol 3 (1) ◽  
pp. 65-68 ◽  
Author(s):  
James W.T. Toh ◽  
Kevin Phan ◽  
Seon-Hahn Kim
Keyword(s):  
Rectal Cancer ◽  
Colorectal Surgery ◽  
Da Vinci Surgical System ◽  
Current Evidence ◽  
Rectal Cancer Surgery ◽  
Cancer Trial ◽  
Robotic Colorectal Surgery ◽  
Significant Difference ◽  
Meta Analyses ◽  
Laparoscopic Assisted

AbstractThere has been a rapid rise in the number of robotic colorectal procedures worldwide since the da Vinci Surgical System robotic technology was approved for surgical procedures in the year 2000. Several recent meta-analyses and systematic reviews have shown a significant difference in outcomes between robotic and laparoscopic rectal cancer surgery. However, these results from pooled data have not been supported by the initial results reported from the Robotic assisted versus laparoscopic assisted resection for rectal cancer trial. In this article, we examine the current evidence for robotic colorectal surgery, assess its features and functionality, evaluate its learning curve and provide our perspective on its future.

scholarly journals The Role of transanal (Ta) dissection in the management of difficult primary and recurrent rectal cancer

2019 ◽  
Vol 6 (1) ◽  
pp. e000305 ◽  
Author(s):  
Valérie Courval ◽  
Sébastien Drolet ◽  
Alexandre Bouchard ◽  
Philippe Bouchard
Keyword(s):  
Rectal Cancer ◽  
Primary Anastomosis ◽  
Rectal Surgery ◽  
Laparoscopic Approach ◽  
Recurrent Rectal Cancer ◽  
Mesorectal Excision ◽  
Final Pathology ◽  
Arterial Bleeding ◽  
History Of ◽  
Difficult Cases

BackgroundThe objective of this study was to review the postoperative and short-term oncological outcomes of our first cohort of patients having had a transanal (Ta) approach for primary or recurrent rectal cancer.MethodsA retrospective chart review was performed on all cases of Ta dissection occurring between 2013 and 2016. We reviewed data concerning case selection, tumour characteristics, perioperative and postoperative data and final pathology.ResultsA total of 24 males were operated for primary (92% (22/24)) or recurrent rectal cancer (8.3% (2/24)). Four patients (16.7% (4/24)) had a history of previous rectal surgery and two had a history of previous Ta total mesorectal excision (TME). A majority of patients were obese, with 58.3% (14/24) having a body mass index >30. The laparoscopic approach was used in the majority of cases (95.8% (23/24)). Most patients had a low anterior resection (95.8% (23/24)). Sixteen patients received a temporary ileostomy (66.7% (16/24)). Three patients suffered perioperative complications (including colonic ischaemia, rectal perforation and arterial bleeding). Five patients (21.7% (5/23)) had an anastomotic leak treated with Ta drainage in two patients. Final pathology revealed negative margins in 95.8% (23/24). TME was considered complete in 87.5% (21/24) overall and in 95% (21/22) when considering only primary cancer cases.ConclusionAccording to our cohort of selected difficult cases, Ta dissection approach helped achieve complete mesorectal excision in complex primary rectal cancer but also allowed for rectal resection in patients with previous rectal surgery. This technique also helped perform a primary anastomosis in these difficult cases.

Incidence of Iatrogenic Ureteral Injury During Open and Laparoscopic Colorectal Surgery

2016 ◽  
Vol 26 (6) ◽  
pp. 513-515 ◽  
Author(s):  
Tom A.T. Marcelissen ◽  
Philip P. Den Hollander ◽  
Tom R.A.H. Tuytten ◽  
Meindert N. Sosef
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Ureteral Injury ◽  
Iatrogenic Ureteral Injury

Survey on consenting practice and discussion of post-operative erectile dysfunction following rectal cancer surgery

2016 ◽  
Vol 10 (1) ◽  
pp. 62-65
Author(s):  
Yih Chyn Phan ◽  
Joseph Sebastian ◽  
Mohan Harilingam ◽  
George Tsavellas
Keyword(s):  
Rectal Cancer ◽  
Erectile Dysfunction ◽  
Rectal Surgery ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Autonomic Nerves ◽  
Pde5 Inhibitors ◽  
Frequency Of Use ◽  
Sexual And Urinary Dysfunction ◽  
Phosphodiesterase Type

Introduction: Sexual dysfunction is a recognized complication of rectal cancer surgery, due to the close proximity of the pelvic autonomic nerves to the normal plane of dissection. The consenting process should therefore always include the risk of sexual and urinary dysfunction arising after such surgery. This survey was undertaken to assess the consenting practice, and to evaluate the frequency of use of phosphodiesterase Type 5 (PDE5) inhibitors to treat erectile dysfunction (ED) following rectal cancer surgery. Methods: All listed Association of Coloproctology of Great Britain and Ireland (ACPGBI) members were invited to participate in the electronic survey, which comprised six questions. By 8 weeks, 119 responses had been received. Results: There were 112 respondents (94.1%) who routinely discussed the risk of ED during the process of gaining consent for rectal cancer surgery. There were 104 respondents (87.3%) who documented ED on their consent form. There were 24 respondents (20.2%) who indicated that there was no stated percentage risk for ED; and there were 69 (58.0%) and 26 (21.9%) respondents who quoted there was a 0–25% and 26–50% risk of ED during the consent process, respectively. None were quoting > 50% risk of ED. There were 68 respondents (57.1%) who routinely enquired about ED during follow-up. There were 30 respondents (25.2%) who stated that they had experience in prescribing PDE5 inhibitors for their patients who suffer from ED: We had 25 of them who felt that patients benefited from using PDE5 inhibitors. Conclusions: The majority of colorectal surgeons routinely discuss and document the risk of ED when consenting for rectal surgery; however, most surgeons have no experience in prescribing PDE5 inhibitors. This is an area that requires further study and education.

scholarly journals EP.TU.1069Improved Perioperative and Survival Outcomes for Minimally Invasive Rectal Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Martin Nnaji ◽  
Kashuf Khan ◽  
Sam Hughes ◽  
Mohit Inani ◽  
Nuha A Yassin
Keyword(s):  
Rectal Cancer ◽  
Survival Data ◽  
Locoregional Recurrence ◽  
Open Surgery ◽  
Rectal Surgery ◽  
Cancer Surgery ◽  
Open Group ◽  
Current Evidence ◽  
Rectal Cancer Surgery ◽  
Significant Difference

Abstract Aim Although laparoscopic colon cancer surgery has been widely embraced as current evidence demonstrates comparable oncological results with open surgery, similar evidence is lacking for laparoscopic rectal cancer surgery. We present the outcomes of patients undergoing laparoscopic and open total mesorectal excision (TME) for rectal cancer in our unit. Methods We retrospectively analysed data collected for patients who underwent laparoscopic and open TME from January 2014 to December 2018. Sociodemographic, perioperative, circumferential resection margin (CRM) positivity, locoregional recurrence and survival data were analysed. Results 260 (144 laparoscopic and 116 open) were included. Median age in the laparoscopic group was 69 years and in the open group 68 years. Neoadjuvant therapy was given in 21 patients (14.6%) in laparoscopic and 13 (11.2%) in the open group (p = 0.42). CRM was positive in 16 cases (11.1%) laparoscopic and 32 (27.6%) open (p = 0.0007;95%CI:6.9-26.2). No statistically significant difference in anastomotic leak rate was observed both groups (4.9% laparoscopic vs 4.3% open;p=0.82). Surgical site infection was significantly more in open cases (13% vs 5.6% laparoscopic,p=0.04). Similar locoregional recurrence rates were observed in both groups (18% laparoscopic vs 19% open,p=0.84). Median follow up was 34 months or more allowed for Disease-free (DFS) and overall survival (OS) to be analysed for 144 of 260 patients. DFS and OS were better in laparoscopic (73% and 94%) compared to open (68% and 85% respectively) (p = 0.40 and p = 0.015 respectively). Conclusion From an oncological perspective, laparoscopic surgery for rectal cancer is safe with additional perioperative and survival benefits compared to open surgery.

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