Application of a Temporary Ileostomy via Median Specimen Extraction Site in Laparoscopic Low Anterior Resection

Objective: To evaluate the feasibility and safety of temporary ileostomy via median specimen extraction site in the lower abdomen. Methods: Twenty-two patients who underwent laparoscopic radical resection for rectal cancer and needed temporary ileostomy were prospectively enrolled. Temporary ileostomy was placed on the median specimen extraction site of the lower abdomen. Intraoperative and postoperative conditions, stoma-related complications and ileostomy reversal surgery were observed. d. Results: Among the 22 patients, there were 14 female patients and 8 male patients: the average age was 56 ±14 years; the average body mass index was 22.0 ±3.4 kg/m2; the average tumour size was 4.4 ±2.2 cm; the average distance between the tumour and the dentate line was 5.9 ±2.3 cm; the average time of laparoscopic low anterior resection was 221 ±56 minutes; the average blood loss was 168 ±91 ml; and the average postoperative hospital stay was 9.9 ±3.9 days. The average ileostomy reversal surgery time was 72 ±15 minutes, the average blood loss was 50 ±27 ml, and the average postoperative hospital stay was 5.9 ±1.0 days. Stoma-related complications occurred in 5 patients, of which one was treated by emergency surgery. Conclusion: In laparoscopic low anterior resection, patients with temporary ileostomy via the median specimen extraction site did not have serious complications that required surgical intervention during hospitalization, and there was no mortality during the perioperative period. It is safe and feasible to perform temporary ileostomies via the median specimen extraction site in the lower abdomen, but for permanent ileostomies, the median site in the lower abdomen should be carefully selected as the ileostomy site.

Inter-ischial spine distance is a simple index of narrow pelvis that may predict difficulty during laparoscopic low anterior resection: a retrospective study

Background A narrow pelvis makes laparoscopic rectal resection difficult. This study aimed to evaluate whether a simple measurement on computed tomography can predict procedural difficulty. Methods A total of 62 patients with low rectal cancer underwent conventional laparoscopic low anterior resection. The inter-ischial spine (IS) distance (i.e., distance between the ischial spines) was measured on an axial computed tomography slice. Operative time, blood loss, and time from insertion of linear staplers to completion of clamping on the distal end of the rectum (clamp time) were compared. Results Overall, 42 men and 20 women with low rectal cancer were assessed. The mean tumor size was 34.5 mm. Total or tumor-specific mesorectal excisions were performed in all cases; high ligation and resection of the inferior mesenteric arteries were carried out in 92% of patients. The mean operative time, and blood loss were 206 min, and 15 mL respectively. Four patients (6.5%) experienced postoperative complications, including two anastomotic leaks (3.2%). The mean IS distance was 93.3 mm. With simple linear regression, shorter IS distance correlated with longer operative time (R2 = 0.08, P = 0.030) and clamp time (R2 = 0.07, P = 0.046). Using an receiver operating characteristic curve, a narrow pelvis was defined as IS distance < 94.7 mm. Multivariate regression analysis revealed that IS distance < 94.7 mm (odds ratio, 3.51; P = 0.04) was independently associated with a longer clamp time. Conclusions The IS distance is a simple and useful measurement for predicting the difficulty of laparoscopic low anterior resection.

Evaluation of the Quality, Educational Value and Utility of the Videos on YouTube for Laparoscopic Low Anterior Resection

Background Minimally invasive surgery is a rising trend in colorectal surgery and is on its way to becoming the gold standard due to the benefits it provides for patients. This study aims to test the efficacy for educational purposes by evaluating the videos published on YouTube ( www.youtube.com ) channel for low anterior resection procedure in rectum surgery. Methods We searched YouTube on October 17, 2020 to choose video clips that included relevant information about laparoscopic low anterior resection (LAR) for rectal cancer. Results We included 25 academics and 75 individual videos in this study. The teaching quality of the videos was evaluated according to academic and individual videos, and it was seen that the teaching quality scores of academic videos were higher and this result was statistically significant ( P = .03). The modified Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS) criteria were found that the score was higher in individual videos ( P = .014). The median Video Power Index (VPI) value was 1.50 (range .05-347) and the mean ratio was 7.01 ± 3.52. There was no statistically significant difference between the 2 groups ( P = .443). Discussion Video-based surgical learning is an effective method for surgical education. Our study showed that the video quality and educational content of most of the videos about the low anterior resection procedure on YouTube were low. The videos of academic origin seem more valuable than individual videos. As far as video popularity is concerned, YouTube viewers are not selective. For this reason, training videos to be used for educational purposes must be passed through a standardized evaluation filter.