Implementation of laparoscopic approach in colorectal surgery – a single center’s experience

AbstractEarly in the 1990s, minimally invasive surgery manifested in laparoscopic surgery found its way to the field of colorectal surgery. Since then, a rising trend in utilizing laparoscopic approach in colorectal surgery, either for benign or malignant disease, is being noticed. In laparoscopic colorectal surgery, the most difficult and challenging step for colorectal surgeons is the mobilization of the splenic flexure. Laparoscopic mobilization of the splenic flexure is an area of debate, with no universally accepted gold standard approach. Multiple approaches have been described in the medical literature and no approach is considered the standard approach. Hence, colorectal surgeons should be familiar with all the different approaches and they should have the ability of utilizing a tailored splenic flexure mobilization approach modified according to patient- and disease-related factors. Herein, we review the different surgical approaches to laparoscopic splenic flexure mobilization that can be tailored to the surgeons needs according to patient- and disease-related factors.

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

Diponegoro International Medical Journal ◽

10.14710/dimj.v2i2.12259 ◽

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.

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Colorectal Surgery

Acute Pain Medicine ◽

10.1093/med/9780190856649.003.0012 ◽

2019 ◽

pp. 145-174

Author(s):

Aaron Persinger ◽

Jeffrey Gonzales

Keyword(s):

Side Effects ◽

Colorectal Surgery ◽

Enhanced Recovery ◽

Average Length ◽

Laparoscopic Approach ◽

Preoperative Preparation ◽

Medication Side Effects ◽

Average Length Of Stay ◽

Medication Side ◽

Recovery Program

Over the past 30 years, the average length of stay after colorectal surgery has decreased from 8 to 10 days in the mid-1990s to 1 to 2 days with a laparoscopic approach in the setting of an enhanced recovery program. The time it takes a patient to return to his or her baseline functional status has also been reduced. This has been achieved by comprehensively addressing the negative physiologic effects of the stress response associated with surgery. Properly timed interventions such as preoperative preparation of the patient, various regional anesthesia techniques, avoidance of medication side effects, and avoidance of postoperative complications seem to work synergistically to speed recovery. This chapter outlines preoperative, intraoperative, and postoperative considerations that may help patients make it through their perioperative journey with increased safety, comfort, and efficiency.

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