Clinical outcomes of 154 hand-assisted laparoscopic surgeries for left sided colon and rectal cancer: single center experience

Background / objectiveHALS technique has provided all the benefits of a minimal invasive surgery, is a safe and effective procedure. Our study was aimed to describe characteristics of patients admitted to Institute of Oncology, Vilnius University due to left sided colon and rectal cancer for hand-assisted laparoscopic surgery (HALS), colorectal resections performed, intraoperative, postoperative, incision and trocar site long-term clinical outcomes.Laparoscopic colectomy is avoided because of its technical difficulty, steep learning curve, and increased operative times. Hand-assisted laparoscopic colectomy is an alternative technique that addresses these problems while preserving the short-term benefits of laparoscopic colectomy. Our study was aimed to describe characteristics of patients admitted due to left sided colon and rectal cancer for hand-assisted laparoscopic surgery (HALS), colorectal resections performed, intraoperative, postoperative, incision and trocar site long-term clinical outcomes.MethodsA prospectively maintained database was used to identify all patients who underwent HALS for left sided colon and rectal cancer at the Institute of Oncology, Vilnius University, from July 1, 2009, when HALS using transumbilical handport incision was started, to October 1, 2013.Results154 HALS colorectal resections were performed. The patients’ mean age was 63±11 years. There were 79 male and 75 female patients. BMI was 27.3 ± 5.8 kg/m2. Forty-four patients (28.5%) have experienced a prior abdominal surgery. The mean HALS time is 105 minutes (55–185). Conversion rate was 3.2% (5/154). The average number of lymph nodes harvested was 15 (3–49). The median of return of gastrointestinal function was 2.5 days (2.2–4.5). The median length of hospital stay was 6.8days (3 – 31). Postoperative complication rate was 9.7%. Two patients (1.3%) demanded explorative laparotomy. Postoperative mortality rate was 0.65%. There were 4 (2.6%) incisional hernias seen on a mean follow-up of 7.0±3.4 months.ConclusionsHALS technique has provided all the benefits of a minimal invasive surgery. HALS colorectal resection is a safe and effective procedure.Keywords: Hand assisted laparoscopic surgery (HALS); Laparoscopic colectomy; Outcomes.Ranka asistuojamų 154 laparoskopinių kolektomijų dėl kairės pusės storosios ir tiesiosios žarnos vėžio rezultatai: vieno centro patirtis Įvadas/ tikslasHALS technika apima visus minimaliai invazyvios chirurgijos privalumus, yra saugi ir efektyvi. Šioje studijoje prospektyviai nagrinėjama pacientų, kuriems dėl kairės pusės storosios ar tiesiosios žarnos vėžio Vilniaus universiteto Onkologijos institutebuvo atlikta ranka asistuojama laparoskopinė kolektomija (HALS), demografiniai rodikliai, procedūros pobūdis, intraoperaciniai ir pooperaciniai duomenys. Pasaulyje kas dešimta kolektomija atliekama laparoskopiškai. Laparoskopija nėra dažna dėl techninių sunkumų, ilgos mokymosi kreivės, ilgesnės operacijos trukmės. Ranka asistuojama laparoskopinė kolektomija minėtų trūkumų neturi.Ligoniai ir metodaiProspektyviai buvo išanalizuotas 154 pacientas, kuriam 2009 07 01 – 2013 10 01 metais Vilniaus universiteto Onkologijos institute buvo atlikta HALS operacija dėl kairės pusės storosios ar tiesiosos žarnos vėžio.RezultataiAtlikta 154 HALS kolorektalinės rezekcijos. Pacientų amžius – 63±11 metai. Operuota 79 vyrai ir 75 moterys. KMI buvo 27,3 ± 5,8 kg/m2. 44 pacientams (28,6 %), anamnezės duomenimis, buvo atliktos pilvo operacijos. Vidutinė operacijos trukmė – 105 minutės (55–185). Konversijų dažnis – 3,2 % (5/154). Vidutinis pašalintų limfmazgių skaičius buvo 15 (3–49). Gastrointestinė funkcija atsitaisė per 2,5 dienos (2,2–4,5). Pooperacinio periodo trukmė – 6,8 dienos (3–31). 9,7 % atvejų pasitaikė komplikacijų. Dviem pacientams (1,3 %) atlikta relaparotomija. Pooperacinio mirtingumo dažnis buvo 0,65 %. Keturiems pacientams (2,6 %) diagnozuotos pooperacinės išvaržos (stebėjimo vidurkis 7,0±3,4 mėn.).IšvadosHALS technika apima visus minimaliai invazyvios chirurgijos privalumus, yra saugi ir efektyvi.Reikšminiai žodžiai: Ranka asistuojama laparoskopinė chirurgija (HALS), laparoskopinė kolektomija, baigtys.

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Hand-assisted laparoscopic surgery for left-sided colon and rectal cancer: 10 Years single centre experience

Acta chirurgica iugoslavica ◽

10.2298/aci1601023r ◽

2016 ◽

Vol 63 (1) ◽

pp. 23-28

Author(s):

Rokas Rackauskas ◽

Audrius Dulskas ◽

Vygintas Aliukonis ◽

Narimantas Samalavicius

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Tertiary Care ◽

Stage Iv ◽

Operation Time ◽

Minimal Invasive ◽

Invasive Technique ◽

Colon And Rectal Cancer

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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Faculty Opinions recommendation of Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718323589.793523137 ◽

2016 ◽

Author(s):

Scott Steele

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Comparative Study ◽

Anterior Resection ◽

Low Anterior Resection ◽

Oncologic Outcomes

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Assessment of Circumferential Resection Margins (CRM) clearance in Conventional open Versus Laparoscopic Cancer Rectum Resection

QJM ◽

10.1093/qjmed/hcab097.024 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ibrahim H Bayan ◽

Ahmed Abdelaziz ◽

Tarek Youssef Ahmed ◽

Mohamed Magdy

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Abdominal Surgery ◽

Open Surgery ◽

Laparoscopic Group ◽

Resection Margins ◽

Laparoscopy Group ◽

Surgery Group ◽

Colon And Rectal Cancer ◽

Significant Difference

Abstract Background Colon and rectal cancer represent the fourth commonest malignancy worldwide. Globally, colon and rectal cancer make up 9.4% and 10.1% in men and women of all cancers, respectively. Colon and rectal tumors are the third most common malignancy after breast and lung cancer, respectively. The main management of rectal cancer involves a multi-disciplinary team approach and an individually tailored treatment routine. Operative surgery remains the primary and definitive treatment for locally confined rectal adenocarcinoma and is the only historical and current treatment which allows for cure. Resection of the colon and rectal cancer can be done either by open surgical excision or laparoscopically. Aim of the work The objective is to compare the radicality of total mesorectal excision for rectal cancer in both open and laparoscopic surgery through the pathology report. Methods In this multicentric, prospective, comparative study, we included the pathologically established rectal cancer patients from 2 hospitals in Cairo, Egypt, Ain Shams University Hospitals and Maadi Military Hospital, Egypt between 2013 and 2016. The sample size was 40 patients divided into two groups; 20 patients for laparoscopic arm and 20 patients for the open trans-abdominal surgery. Inclusion criteria: histopathology confirmed rectal cancer, patients fit for operative resection, and with T1- T3 grades according to the preoperative evaluation. The exclusion criteria: Patients with T4 stage tumor, patients present as emergency cases and patients present with recurrence of the tumor and synchronous colonic tumors. Results The circumferential resection margins (CRM) of the mesorectum when examined pathologically after resection showed no difference between the two arms of the study with laparoscopic group specimens 3.18±1.16 mm mean, (SD) compared to 3.50±0.45 mm mean, (SD) in the open surgery group with no statistically significant difference. The longitudinal resection margins (LRM) was (5.50±1.98 mean, SD) in the laparoscopic group compared to (5.20±2.28 mean, SD) in the open conventional surgery group with no significant difference found between the two groups. Total operative time was significantly shorter in the trans-abdominal surgery group, while the hospital stay period was significantly shorter in the laparoscopy group. Laparoscopy group also showed significantly time before flatus passage, and the patients in the laparoscopy group started oral intake faster than open surgery group. Conclusion In our study, the radicality of the rectal cancer excision in both laparoscopic and traditional open surgery, showed non inferiority of the laparoscopic technique over open surgery Long-term clinical outcomes of overall survival and recurrence is the foremost parameters which should be taken in consideration for decision for laparoscopic surgery for rectal cancer. Additional follow-up results from the current trial are presently being developed, beside with records on other secondary end points, like cost effectiveness and quality of life.

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Response to Bell et al ., ‘The effect of increasing body mass index on laparoscopic surgery for colon and rectal cancer’

Colorectal Disease ◽

10.1111/codi.14345 ◽

2018 ◽

Vol 20 (10) ◽

pp. 931-931

Author(s):

S. K. Sood ◽

P. Kang ◽

U. Ihedioha ◽

J. Evans

Keyword(s):

Body Mass Index ◽

Rectal Cancer ◽

Laparoscopic Surgery ◽

Body Mass ◽

Colon And Rectal Cancer

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Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs

Toxicologic Pathology ◽

10.1177/01926233211067960 ◽

2021 ◽

pp. 019262332110679

Author(s):

Yuval Ramot ◽

Serge Rousselle ◽

Michal Steiner ◽

Yossi Lavie ◽

Nati Ezov ◽

...

Keyword(s):

Minimal Invasive Surgery ◽

Minimal Invasive ◽

Experimental Conditions ◽

Single Action ◽

Treatment Groups ◽

Novel Device ◽

Fibrotic Scar ◽

And Performance ◽

Tissue Approximation

One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.

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