scholarly journals Laparoskopinė storosios žarnos chirurgija Vilniaus universiteto Onkologijos institute

2008 ◽  
Vol 6 (4) ◽  
pp. 0-0
Author(s):  
Narimantas Evaldas Samalavičius ◽  
Giedrė Rudinskaitė ◽  
Alfredas Kilius ◽  
Artur Mečkovski
Keyword(s):  
Colorectal Surgery ◽  
Total Mesorectal Excision ◽  
Laparoscopic Colorectal Surgery ◽  
Operating Time ◽  
Mesorectal Excision ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Open Conversion ◽  
Keywords Colorectal Cancer ◽  
Vilnius University

Narimantas Evaldas Samalavičius1, 2, Giedrė Rudinskaitė2, Alfredas Kilius2, Artur Mečkovski21 Vilniaus universiteto Medicinos fakulteto Vidaus ligų, šeimos medicinos ir onkologijos klinika,Santariškių g. 2, LT-08661 Vilnius2 Vilniaus Universiteto Onkologijos instituto, Chirurgijos klinika, Santariškių g. 1, LT-08660 VilniusEl paštas: narimantas.samalavič[email protected] Darbo tikslas Surinkti ir išanalizuoti duomenis apie laparoskopines storosios žarnos operacijas, atliktas Vilniaus universiteto Onkologijos instituto Chirurgijos klinikoje nuo 2006 m. vasario 23 d. iki 2008 m. liepos 23 d Ligoniai ir metodai Minėtu laikotarpiu Vilniaus universiteto Onkologijos institute atliktos 47 laparoskopinės operacijos dėl storosios žarnos patologijos. Operuoti 23 vyrai ir 15 moterų, amžius nuo 22 iki 82 metų, vidurkis 65 metai. Laparoskopiškai pradėtos iš viso 49 operacijos, 2 operacijos konvertuotos į atvirąsias (konversijų procentas 4,1% ligonių). 42 operuoti dėl piktybinių ligų, 5 – dėl kitų ligų. Iš 42 ligonių, operuotų dėl piktybinių ligų, 3 (7,1%) buvo 0 stadijos, 5 (11,9%) – I stadijos, 17 (40,5%) – II stadijos, 8 (19%) – III stadijos ir 9 (21,4%) – IV stadijos vėžys. Kiti 5 ligoniai operuoti dėl šeiminės polipozės (1), opinio kolito (1), riestinės žarnos divertikulito ir striktūros (1), tiesiosios žarnos tubuloviliozinės adenomos (2). Atlikta 12 abdominoperinealinių tiesiosios žarnos rezekcijų, 14 tiesiosios žarnos rezekcijų su daline TME, 4 tiesiosios žarnos rezekcijos su visiška TME ir ileostomija, 9 riestinės gaubtinės žarnos dalies rezekcijos, 1 rektosigminė rezekcija, 2 dešinės hemikolektomijos, 2 rekonstrukcinės proktokolektomijos, 2 subtotalinės kolektomijos su ileorektostomija ir 1 laparoskopinė polipektomija. 16 (38,1%) operacijų atliktos tik laparoskopiškai, o 26 (61,9%) – laparoskopiškai asistuojant ranka. Operacijos truko nuo 50 minučių iki 7 valandų 30 minučių, vidutiniškai 2 valandas ir 54 minutes. Rezultatai Bendra hospitalizacijos trukmė buvo 8–26 dienos, vidutiniškai 14 dienų, pooperacinė hospitalizacijos trukmė buvo 4–20 dienų, vidutiniškai 10 dienų. Pooperacinė eiga komplikavosi 13 (27,7%) pacientų, iš kurių dėl komplikacijų buvo peroperuoti 2 (4,3%). Komplikacijos buvo tokios: eventeracija (2 pacientams, jie buvo peroperuoti), žaizdos infekcija (4), pilvo sienos flegmona (1), pilvo ertmės infiltratas (1), šlapimo susilaikymas (3), plaučių uždegimas (1), ūminis širdies ir kraujagyslių sistemos nepakankamumas (1). Pooperaciniuose preparatuose rasta nuo 2 iki 71 limfmazgio, vidutiniškai 14 limfmazgių. Išvados Vilniaus universiteto Onkologijos institute 2006 02 23–2008 07 23 buvo įvaldyta laparoskopinė storosios žarnos chirurgija. Pirmoji patirtis parodė, kad ji saugi ir palyginama su atvirąja chirurgija. Vėlyviems rezultatams įvertinti pooperacinio stebėjimo laikas dar yra per trumpas. Reikšminiai žodžiai: storosios žarnos vėžys, laparoskopinė chirurgija, komplikacijos Laparoscopic colorectal surgery at the Oncology Institute of Vilnius University Narimantas Evaldas Samalavičius1, 2, Giedrė Rudinskaitė2, Alfredas Kilius2, Artur Mečkovski21 Medical Faculty of Vilnius Univerity, Clinic of Internal, Family Medicine and Oncology,Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Oncology Insitute of Vilnius University, Clinic of Surgery,Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: narimantas.samalavič[email protected] Objective The study was aimed to analyse data on laparoscopic colorectal surgery performed at the Oncology Institute of Vilnius University during the period 23 02 2006 to 23 07 2008. Patients and methods During the above-mentioned period, a total of 47 patients were operated on laparoscopically for colorectal disorders, of them 23 were males and 15 females aged 22 to 82 years, mean 65 years. From 49 attempted laparoscopic surgeries, 2 were converted into open (conversion rate 4.1%). 42 were operated on for malignancies: for stage 0 – 3 (7.1%), stage I – 5 (11.9%), stage II – 17 (40.5%), stage III – 8 (19%) and stage IV – 9 (21.4%). The rest 5 patients were operated for benign conditions: familial polyposis (1), ulcerative colitis (1), diverticular disease (1) and tubulovillous rectal adenoma (2). 12 underwent abdominoperineal resections, 14 – partial total mesorectal excision, 4 total mesorectal excision with ileostomy, 9 sigmoid resections, 1 rectosigmoid resection, 2 right hemicolectomies, 2 restorative proctocolectomies (ileoanal J pouch), 2 subtotal colectomies with ileostomy and 1 polypectomy from descending colon. 16 (38.1%) were straight laparoscopic procedures, and 26 (61.9%) were hand-asisted laparoscopic surgeries. Operating time ranged from 50 minutes to 7 hours 30 minutes, meane 2 hours 54 minutes. Results Median hospital stay was 14 days, range 8–26, postoperative stay was 10 days, range 4–20. The postoperative course was complicated in 13 (27.7%) cases: eventeration in 2 patients (they underwent reoperation, reoperation rate 4.3%), wound infection in 4, urinary retention in 3, phlegmon of the abdominal wall in 1, intraabdominal infiltratus in 1, pneumonia in 1 and acute cardiovascular insufficienty in 1. In postoperative specimens, the mean lymph node harvest was 14, range 2–71. Conclusion At the Oncology Institute of Vilnius University, during the period from 23 02 2006 to 23 07 2008, laparoscopic colorectal surgery was implemented successfully. It was safe and comparable to open surgery. To evaluate the long-term outcome, the above period of observation is not sufficient. Keywords: colorectal cancer, laparoscopic surgery, complications

Supervised surgical training and its effect on the short-term outcome in laparoscopic colorectal surgery

2013 ◽  
Vol 15 (8) ◽  
pp. e483-e487 ◽  
Author(s):  
A. Krishna ◽  
M. Russell ◽  
G. L. Richardson ◽  
M. J. F. X. Rickard ◽  
A. Keshava
Keyword(s):  
Colorectal Surgery ◽  
Surgical Training ◽  
Laparoscopic Colorectal Surgery ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome

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

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

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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, <i>p</i> = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, <i>p</i> &#x3c; 0.001), longer operating time (3.2 vs. 2.5 hours, <i>p</i> &#x3c; 0.001), and more readmissions (10.9 vs. 8.5%, <i>p</i> &#x3c; 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, <i>p</i> &#x3c; 0.001), less morbidity (37.3 vs. 55.1%, <i>p</i> &#x3c; 0.001), and less mortality (1.8 vs. 5.6%, <i>p</i> = 0.013) for laparoscopy. <b><i>Conclusion:</i></b> 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.

Comparison of the long-term outcome of cemented Charnley low-friction arthroplasty with hybrid arthroplasty in patients with congenital hip disease

2019 ◽  
Vol 101-B (9) ◽  
pp. 1050-1057
Author(s):  
Kalliopi Lampropoulou-Adamidou ◽  
George Hartofilakidis
Keyword(s):  
Operating Time ◽  
Long Term Results ◽  
Low Friction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Hip Disease ◽  
Group A ◽  
Group B

Aims To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. Patients and Methods Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. Results At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). Conclusion We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050–1057.

Sphincter-Saving Robotic Total Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal Cancer

2021 ◽  
Author(s):  
Vusal Aliyev ◽  
Suha Goksel ◽  
Barıs Bakır ◽  
Koray Guven ◽  
Oktar Asoglu
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Local Control ◽  
Operating Time ◽  
Laparoscopic Group ◽  
Low Rectal Cancer ◽  
Mesorectal Excision ◽  
Oncological Outcomes ◽  
Sphincter Saving ◽  
Male Patients

Introduction: Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. The aim of our study was to compare long-term oncological outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision in male patients with mid-low rectal cancer. Materials and Methods: The study was conducted as a retrospective review of a prospectively maintained database. One-hundred-three robotic and 84 laparoscopic sphincter-saving total mesorectal excisions were performed by a single surgeon between January 2011 and January 2020. Patient characteristics, perioperative recovery, postoperative complications, pathology results, and oncological outcomes were compared between the two groups. Results: The patients’ characteristics did not differ significantly between the two groups. Median operating time was longer in the robotic than in the laparoscopic group (180 minutes versus 140 minutes, p=0.033). Macroscopic grading of the specimen in the robotic group was complete in 96 (93.20%), near complete in four (3.88%) and incomplete in three (2.91%) patients. In the laparoscopic group, grading was complete in 37 (44.04%), near complete in 40 (47.61%) and incomplete in seven (8.33%) patients (p=0.03). The median length of follow up was 48 (9–102) months in the robotic, and 75.6 (11–113) months in the laparoscopic group. Overall, five-year survival was 87% in the robotic and 85.3% in the laparoscopic groups. Local recurrence rates were 3.8% and 7.14%, respectively, in the robotic and laparoscopic groups (p<0.05). Conclusion: Sphincter-saving robotic total mesorectal excision is a safe and feasible tool, which provides good mesorectal integrity and better local control in male patients with mid-low rectal cancer.

SP1.2.5Robot-assisted Colorectal Surgery: Short-term Outcome of First 70 cases at Different Time-intervals along the Learning Curve

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sandeep Singh ◽  
William Rea ◽  
Shaun Nai ◽  
Tamas Sollei ◽  
Neil Kukreja ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Learning Curve ◽  
Operating Time ◽  
Total Duration ◽  
Time Intervals ◽  
Term Outcome ◽  
Female Ratio ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Aim To analyse the evolution of robot-assisted colorectal surgery (RACS). Methods All the patients who underwent RACS between June 2018 and December 2020 were selected. Study period was divided into 3 intervals along the learning curve; group A represents the 1st 10 months, group B 2nd 10 and group C last 11. Results Over the 31-month study period, 70 RACS were performed. Male to female ratio was 4:3, with mean age of 66 years and BMI 28.7. ASA score was reported as 1-2 in 65% patients and 35% as 3. Indication was malignancy for 89% patients and the remainder benign pathology. High or low anterior resection performed were 72%, right hemicolectomies 21%, Hartmann’s 3%, abdominoperineal resections 3%, and left hemicolectomy 1%. RACS performed in group A was 20 compared to 19 in B and 31 C. Type of RACS performed, BMI, ASA, complications, anastomotic leaks, R0 resections and harvested lymph nodes were unrelated to selected time-intervals along learning curve. Mean total duration of procedure dropped down to 247 minutes in group C from 375 in group A (p = &lt;0.001). No significant difference in mean length of stay and readmission rate was observed in 3 groups (p = 0.7, p = 0.59). Conclusion The study demonstrates that introduction of this new surgical technique is safe even in the early phase of adoption with no significant difference in pre-and post-operative morbidities. Significant difference in time taken for surgery was observed with reduction of 88 minutes in average operating time between the start and end of the study.

scholarly journals Transanal total mesorectal excision for rectal cancer: a multicentric cohort study

2019 ◽  
Vol 8 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Liang Kang ◽  
Yuan-Guang Chen ◽  
Hao Zhang ◽  
Hong-Yu Zhang ◽  
Guo-Le Lin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Survival Rates ◽  
Operating Time ◽  
Disease Free Survival ◽  
Oncologic Outcomes ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Kaplan Meier

Abstract Background Transanal total mesorectal excision (taTME) has recently emerged as a promising novel surgical procedure for rectal cancer. It is believed to hold the potential advantage of providing better access to mobilize the distal rectum and achieving better pathologic results. This study aimed to evaluate the feasibility of taTME for rectal cancer and summarize the preliminary experience in 10 Chinese hospitals. Methods A total of 211 patients were enrolled in this study. Variables for evaluation of safety, feasibility, and oncologic outcomes were retrospectively collected and analysed. Results The median distance between the tumor and the anal verge was 5.9 cm (range, 1.5–12 cm). The median operating time was 280 min (range, 70–600 min) and the median estimated intra-operative blood loss was 50 mL (range, 10–1,500 mL). The overall rate of complication was 27.9%. Among the 211 patients, 175 (82.9%) had complete TME and 33 (15.6%) had near complete TME. The circumferential resection margin was negative in 97.7% of patients. The patients were followed for a median of 35 months (range, 2–86 months). There was 7.6% (16) mortality, 6.2% (13) had local recurrence, and 12.8% (27) had systemic recurrence. Kaplan–Meier survival analysis showed that 1-, 2-, and 3-year disease-free survival rates were 94.8%, 89.3%, and 80.2%, respectively, and 1-, 2-, and 3-year OS rates were 97.4%, 95.7%, and 92.9%, respectively. Conclusions Although limited by its retrospective nature, taTME was safe and feasible in selected patients. Future work with rigorous data recording is warranted.

scholarly journals LAPAROSCOPIC COLORECTAL SURGERY;

2018 ◽  
Vol 21 (04) ◽  
pp. 583-586
Author(s):  
Zulfiqar Hanif ◽  
Muhammad Attique ◽  
Haitham Qandeel ◽  
Abdul Latif Khan
Keyword(s):  
Colorectal Surgery ◽  
Hospital Stay ◽  
Laparoscopic Colorectal Surgery ◽  
Laparoscopic Group ◽  
Open Group ◽  
Port Site Recurrence ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
The Mean

Objective: The aim of this study was to assess the outcome of laparoscopiccolorectal procedures performed in a district general hospital within 5 years period and tocompare it with patients who had an open procedure during the same period. Patients andMethods: Data were collected retrospectively from patient’s case notes retrieved from hospitalmedical records. One hundred consecutive cases of laparoscopic colonic resection includingboth benign and malignant diseases between 2005 and 2010 were analysed for perioperativeand long term outcome and were compared with consecutive one hundred cases of opencolectomies. Results: Overall conversion rate was 6% for laparoscopic group. The mean majorcomplication rates in laparoscopic group were 5% (3% in open group) and minor complicationsoccurred in 18% (28% in open group). There was no mortality in either group. The overallmorbidity rate was 23% in laparoscopic group as compared to 31% in open colectomy group. In64 cases, curative laparoscopic resections were performed for colorectal malignancy while 72patients had resections for cancer in open group. The mean lymph node harvest in laparoscopicgroup was 13.2 nodes as compared to 12.4 in open group; no port-site recurrence wasdocumented at a mean follow-up of 26 months. Average duration of surgery was 180 minutes ascompared to 140 minutes in open group. Mean postoperative hospital stay was reduced from 13days to 7 days. (Open Vs. Lap). There was no statistically significant difference in majorcomplication rates and mortality. Conclusions: Laparoscopic colorectal surgery is safe andfeasible in elective colorectal cases and reduces the hospital stay without any added morbidity.

scholarly journals Laparoskopinė storosios žarnos chirurgija: pirmoji patirtis Lietuvoje

2006 ◽  
Vol 4 (4) ◽  
pp. 0-0
Author(s):  
Gintarė Valeikaitė ◽  
Juozas Stanaitis ◽  
Nerijus Kaselis ◽  
Eligijus Poškus ◽  
Kęstutis Strupas ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Operative Time ◽  
Laparoscopic Colorectal Surgery ◽  
University Hospital ◽  
Colorectal Disease ◽  
City Hospital ◽  
Benign Colorectal Disease ◽  
The Mean ◽  
Vilnius University ◽  
Accepted Practice

Gintarė Valeikaitė1, Juozas Stanaitis2, Nerijus Kaselis3, Eligijus Poškus4, Kęstutis Strupas4, Dainius Pavalkis11 Kauno medicinos universiteto klinikų Chirurgijos klinika;2 Vilniaus universiteto Bendrosios ir plastinės chirurgijos, ortopedijos ir traumatologijos klinika;3 Klaipėdos apskrities ligoninės Chirurgijos skyrius;4 Vilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas Šio straipsnio tikslas – įvertinti pirmąją laparoskopinės storosios žarnos chirurgijos praktiką Lietuvoje ir supažindinti su pasauline patirtimi. Metodai Sudarytas klausimynas išsiųstas keturiems pagrindiniams Lietuvos centrams, kuriuose atliekamos storosios žarnos laparoskopinės operacijos. Išnagrinėti 56 atliktų operacijų duomenys. Trisdešimt šeši (64,3%) pacientai buvo operuoti nuo vėžio: penkiolika – nuo riestinės, vienuolika – tiesiosios, keturi – kylančiosios, trys – aklosios, du – skersinės ir vienas – nusileidžiančiosios žarnos vėžio. Nuo nepiktybinių storosios ir tiesiosios žarnos ligų operuota dvidešimt (35,7%) pacientų: aštuoni – nuo divertikuliozės, aštuoni – tiesiosios žarnos iškritimo, keturi – pailgėjusios riestinės žarnos. Vidutinis moterų amžius – 64,9 metų, vyrų – 59,7 metų. Rezultatai Buvo atlikta septyniolika aukštų priekinių tiesiosios žarnos rezekcijų, vidutinė operacijos trukmė (VOT) – 203,9 min., penkiolika dešinių hemikolektomijų, VOT – 212 min., devynios kairios hemikolektomijos, VOT – 221,4 min., šešios riestinės žarnos rezekcijos, VOT – 194 min., trys riestinės ir tiesiosios žarnos rezekcijos, VOT – 220 min, aštuonios rektopeksijos, VOT – 179,5 min., viena tiesiosios žarnos ekstirpacija, VOT – 255 min. Visos žarnų jungtys buvo padarytos intrakorporaliniu būdu, išskyrus dešinę hemikolektomiją, kai jungtis padaroma išorėje per minilaparotominį pjūvį dešinėje pilvo sienos pusėje. Konversijos priežastys dviem atvejais buvo kraujavimas iš pasaito ir dviem atvejais – peraugęs į gretimus organus navikas. Vidutiniškai prieš operaciją ligoniai gulėjo 3,2 dienos, po operacijos – 8,3 dienos. Išvada Laparoskopinis metodas toliau vertinamas atliekant perspektyvųjį nacio nalinį tyrimą. Reikšminiai žodžiai: laparoskopija, storoji žarna, chirurgija First experience in laparoscopic colorectal surgery in Lithuania Gintarė Valeikaitė1, Juozas Stanaitis2, Nerijus Kaselis3, Eligijus Poškus4, Kęstutis Strupas4, Dainius Pavalkis11 Kaunas University of Medicine, Clinic of Surgery;2 Vilnius University Clinic of General, Plastic Surgery, Orthopedic and Traumatology;3 Klaipėda City Hospital;4 Vilnius University Hospital Santariškių Klinikos, Centre of Abdominal Surgery,Santariškių 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Objective To evaluate the first experience in laparoscopic colorectal surgery in Lithuania and to review the worldwild accepted practice. Methods A questionnaire was sent to four major centers performing laparoscopic colorectal surgery in Lithuania. Analysis of obtained data showed that 56 laparoscopic operations were performed. For colorectal cancer were operated 36 patients (64.3%): 11 for rectal, 15 for sigmoid, 4 for ascending colon, 3 for ceacal, 2 for transversal and 1 for descending colon cancer. For benign colorectal disease – 20 (35.7%): 8 for diverticular disease, 8 for rectal prolapse, 4 for constipation caused by sigmoid elongation. The mean age of males was 59.7 and of females – 64.9 years. Results There were performed 15 laparoscopic left hemicolectomies (the mean operative time (MOT) 212 min), 17 laparoscopic high rectal resections (MOT 203.9 min), 9 laparoscopic right hemicolectomies (MOT 221.4 min), 6 sigmoid resections (MOT 194 min), 3 sigmoid and rectal resections (MOT 220 min), 8 laparoscopic rectopexies (MOT 179.5 min) and one laparoscopic abdominoperineal resection, operative time 255 min. All the anastomoses were intracorporeal, except right hemicolectomies and sigmoid resections. The reasons for conversion were bleeding from mesenterium in 2 cases and advanced tumours in 2 cases. The mean preoperative stay was 3.2 and postoperative stay 8.3 days. Conclusions There could not be clear conclusions, and the laparoscopic method is being further evaluated by a prospective national trial. Key words: laparoscopic colorectal surgery

scholarly journals Laparoskopinė ranka asistuojama storosios žarnos chirurgija naudojant transumbilikalinį pjūvį

2011 ◽  
Vol 9 (3-4) ◽  
Author(s):  
Vilma Brazytė ◽  
Narimantas Evaldas Samalavičius ◽  
Renatas Tikuišis ◽  
Povilas Miliauskas
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Abdominal Cavity ◽  
Stage Iv ◽  
Colorectal Adenomas ◽  
Colon Perforation ◽  
Short Operative Time ◽  
Chron's Disease ◽  
Vilnius University ◽  
Hand Port

Vilma Brazytė1, Narimantas Evaldas Samalavičius1, Renatas Tikuišis2, Povilas Miliauskas2 1 Vilniaus universiteto Onkologijos instituto Chirurgijos klinika, Santariškių g. 1, LT-08660 Vilnius ir Vilniaus universiteto Medicinos fakulteto Vidaus ligų, šeimos medicinos ir onkologijos klinika2 Vilniaus universiteto Onkologijos instituto Intensyviosiosios terapijos ir anesteziologijos skyrius, Santariškių g. 1, LT-08660 Vilnius El. paštas: [email protected] TikslasIšanalizuoti chirurginius rezultatus po laparoskopinių ranka asistuojamų storosios žarnos operacijų, atliktų nuo 2009 07 01 iki 2010 12 31 Vilniaus universiteto Onkologijos instituto Chirurgijos klinikoje, laparoskopinį diską įkišus per transumbilikalinį pjūvį. Ligoniai ir metodaiPer 18 mėnesių Vilniaus universiteto Onkologijos institute atlikta 51 laparoskopinė ranka asistuojama storosios žarnos operacija naudojant transumbilikalinį laparoskopinio disko pjūvį. Operuoti 25 vyrai ir 26 moterys, kurių amžius svyravo nuo 37 iki 84 metų, vidurkis 63 metai. Atliktos 22 (43 %) tiesiosios žarnos rezekcijos ir dalinė totalinė mezorektalinė ekscizija (TME) dėl navikų viršutiniame tiesiosios žarnos ampulės trečdalyje, 16 (31 %) kairės pusės hemikolektomijų, 8 (16 %) riestinės žarnos rezekcijos, 3 (6 %) skersinės žarnos rezekcijos, 2 (4 %) rektosigminės dalies rezekcijos. 45 (88 %) ligoniai operuoti dėl storosios žarnos vėžio, 4 (8 %) – dėl endoskopiškai nepašalinamų storosio žarnos adenomų ir 2 (4 %) – dėl storosios žarnos Kronos ligos. Iš 45 ligonių, operuotų dėl storosios žarnos vėžio, 3 buvo 0 stadijos (pTis), 12 – I stadijos, 11 – II stadijos, 16 – III stadijos, 3 – IV stadijos. Operacijos truko nuo 50 minučių iki 3 valandų 5 minučių, vidutiniškai 1 valandą ir 45 minutes. RezultataiVidutinė bendra hospitalizacijos trukmė buvo 10 dienų, pooperacinė gulėjimo trukmė – 8 dienos (nuo 4 iki 30 dienų). Pooperacinė eiga komplikavosi 4 (8 %) ligoniams: vienam – žarnos perforacija virš jungties ir susidaręs parakolinis pūlinys, vienam – kraujavimas iš anastomozės, vienam – pilvo ertmės infiltratas, vienam – žaizdos infekcija. Pakartotinai operuotas 1 (2 %) ligonis: dėl žarnos perforacijos ir susidariusio pūlinio atlikta laparotomija, pūlinio drenavimas, žarna susiūta ir suformuota prevencinė ileostoma. Ligonių, operuotų dėl storosios žarnos vėžio (45), pooperaciniuose preparatuose rasta nuo 8 iki 54 limfmazgių, vidurkis 16 limfmazgių. IšvadaLaparoskopinė ranka asistuojama storosios žarnos chirurgija per transumbilikalinį pjūvį buvo saugi ir patikima laparoskopinės chirurgijos alternatyva, susijusi su nedideliu komplikacijų skaičiumi ir neilga operacijos trukme. Jos ankstyvieji chirurgai ir kosmetiniai rezultatai buvo geri. Reikšminiai žodžiai: ranka asistuojama laparoskopinė chirurgija, storosios žarnos vėžys, komplikacijos. Hand-assisted laparoscopic colorectal surgery via transumbilical incision Vilma Brazytė1, Narimantas Evaldas Samalavičius1,Renatas Tikuišis2, Povilas Miliauskas2 1 Oncology Institute of Vilnius University, Clinic of Surgery,Santariškių Str. 1, LT-08660 Vilnius, Lithuania2 Oncology Institute of Vilnius University, Intensive Care and Anestesiology Department, Santariškių Str. 1, LT-08660 E-mail: [email protected] ObjectiveAnalysis of results of hand-assisted laparoscopic colorectal surgery via transumbilical hand-port incision, performed at the Oncology Institute of Vilnius University from 1 July 2009 to 31 December 2010. Patients and methodsFifty-one patients underwent hand-assisted laparoscopic colorectal surgery over a period of eighteen months. There were 25 males and 26 females, age range 37 to 84 years, mean 63 years. Twenty-two (43%) patients underwent rectal resections with partial total mesorectal excision (TME) for superior third rectal tumours, 16 (31%) left hemicolectomies, 8 (16%) sigmoid resections, 3 (6%) transverse colon resections, 2 (4%) rectosigmoid resections. Forty-five (88%) patients were operated on for malignancies: for stage 0 (pTis) – 3, stage I – 12, stage II – 11, stage III – 16, stage IV – 3. Others were operated on for benign diseases: endoscopically inextirpable colorectal adenomas 4 (8%) and Chron’s disease 2 (4%). The operations lasted from 50 minutes to 3 hours and 5 minutes, on average 1 hour and 45 minutes. ResultsThe median in-hospital stay was 10 days, postoperative stay 8 days, range 4–30 days. Complications occurred in 4 (8%) patients: colon perforation above anastomosis and paracolical abscess in one patient (he underwent laparotomy, drainage of abscess, suture of colon defect and preventive ileostomy), bleeding from anastomosis site in 1, infiltration in abdominal cavity in 1, wound infection also in 1 patient. In the postoperative patients operated on for colorectal cancer, the mean lymph node harvest was 16, range 8–54. ConclusionHand-assited laparoscopic colorectal surgery via transumbilical hand-port incision was a safe and reliable alternative to straight laparoscopic surgery, related to a low complication rate, short operative time and showed good short-term surgical and cosmetic results. Keywords: hand-assited laparoscopic colorectal surgery, colon cancer, complications.

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