Ureteral injury during laparoscopic rectal resection and concurrent laparoscopic repair by uretero-ureterostomy

Iatrogenic ureteral injury is an uncommon but severe complication of laparoscopic colorectal surgery. If it is detected intraoperatively, conversion to open surgery is usually inevitable. Here, we described a complete ureteral transection during laparoscopic low anterior resection, which was simultaneously repaired by laparoscopic uretero-ureterostomy. The most important points during the anastomosis of two tiny tubular tissues are dissecting the tubular organs without trauma, obtaining meticulous hemostasis without causing any necrosis, and achieving accurate approximation of tissues with the sutures. To the best of our knowledge, this is the first report that focused on laparoscopic repair of ureteral injury during laparoscopic colorectal surgery. As there are still few data on laparoscopic repair of ureteral lesions, no firm conclusions can be drawn. But, in appropriate cases, if intracorporeal suture expertise is available, laparoscopic repair can be done during colorectal surgery.

TP7.2.5 Surgeon measured radiological pelvic measurements as a patient selection tool for laparoscopic rectal resection – an aide in early learning curve

Introduction Rectal resections are considered one of the most technically demanding laparoscopic procedures. This study reviews one unit’s rectal cancer resections to determine whether pelvic dimensions measured by the surgeon could aide patient selection for laparoscopic resections. Methods A prospectively maintained database was used to identify rectal cancer resections between April 2015 to March 2018 and patient demographics, BMI, height of tumour and operative details were in extracted. Anteroposterior (Coccygio-pubic) and transverse (interspinous) distance were measured retrospectively on linked Axial & Saggital views on staging CT scans. Tumour dimensions in the respective planes were recorded and relative proportions of tumour to pelvic dimensions calculated. These were correlated to operative approach. Results Our cohort comprised of 70 patients (42 men) with a median BMI of 27 and mean age of 71. While 6 operations were planned as open procedures, 64 were attempted laparoscopically. Of these, 55 were completed laparoscopically and 9 were converted (16%). There was no correlation between gender and operative approach (p = 0.2). Mean BMI for laparoscopic group 28.7 and converted group 30.0 which was not statistically significant (p = 0.32). Conversion was more likely for low tumours (89%). Median tumour to pelvic area proportion was 0.14 laparoscopic compared to 0.03 for open and 0.03 for converted suggesting that bulkier tumours are more likely to need conversion. Discussion None of previously identified factors such as gender and BMI predicted conversion in our cohort individually. Tumour size relative to pelvic dimensions is a simple measure a surgeon could use to guide patient selection.

Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture After Laparoscopic Rectal Resection for Rectal Cancer

Background: Laparoscopic rectal resection may cause various surgical complications including perineal hernia and adhesive small-bowel obstruction. Pelvic peritoneum reconstruction (PPR) could prevent those complications. The aim of the study is to evaluate the short-term clinical, technical and safety outcomes of PPR using the barbed suture in laparoscopic rectal resection. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. Between January 2014 and December 2019, a total of 402 patients who underwent curative surgery for rectal cancer in Chengdu Second People’s Hospital were enrolled in the study. Among them, 216 patients who underwent laparoscopic rectal resection with PPR were allocated into the experimental group, and 186 patients who underwent laparoscopic rectal resection without PPR were allocated into control group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. The data were represented by X ± s. t-test and X2 test were used for counting data. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion We hypothesized that pelvic peritoneum reconstruction with barbed suture could improve the efficiency of intracorporeal closure of the pelvic cavity after in laparoscopic rectal resection, which can significantly reduce postoperative perineal-related complications. Further, we expect that use of the barbed sutures will reduce intra-operative stress on the endoscopic surgeon.

Lower conversion rate with robotic assisted rectal resections compared with conventional laparoscopy; a national cohort study

Background Conversion from laparoscopic to open access colorectal surgery is associated with a poorer postoperative outcome. The aim of this study was to assess conversion rates and outcomes after standard laparoscopic rectal resection (LR) and robotic laparoscopic rectal resection (RR). Methods A national 5-year cohort study utilizing prospectively recorded data on patients who underwent elective major laparoscopic resection for rectal cancer. Data were retrieved from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry. Primary end point was conversion rate. Secondary end points were postoperative complications within 30 days and histopathological results. Chi-square test, two-sided T test, and Mann–Whitney U test were used for univariable analyses. Both univariable and multivariable logistic regression analyses were used to analyze the relations between different predictors and outcomes, and propensity score matching was performed to address potential treatment assignment bias. Results A total of 1284 patients were included, of whom 375 underwent RR and 909 LR. Conversion rate was 8 out of 375 (2.1%) for RR compared with 87 out of 909 (9.6%) for LR (p < 0.001). RR was associated with reduced risk for conversion compared with LR (aOR 0.22, 95% CI 0.10–0.46). There were no other outcome differences between RR and LR. Factors associated with increased risk for conversion were male gender, severe cardiac disease and BMI > 30. Conversion was associated with higher rates of major complications (20 out of 95 (21.2%) vs 135 out of 1189 (11.4%) p = 0.005), reoperations (13 out of 95 (13.7%) vs 93 out of 1189 (7.1%) p = 0.020), and longer hospital stay (median 8 days vs 6 days, p = 0.001). Conclusion Conversion rate was lower with robotic assisted rectal resections compared with conventional laparoscopy. Conversions were associated with higher rates of postoperative complications.

The Impact of Complications on Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture in Laparoscopic Rectal Resection for Rectal Cancer

Objective: This study aimed to evaluate the safety and short-term outcomes of pelvic peritoneum reconstruction with barbed sutures in laparoscopic rectal resection for rectal cancer. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. The clinicopathological data of 402 patients with rectal cancer admitted to our department hospital from January to December 2019 were collected. There was total of 402 patients, including 218 males and 174 females, with an average age of 68 years. Among them, 216 patients who underwent laparoscopic rectal resection with pelvic peritoneum reconstruction (PPR) were allocated into the PPR group, and 186 patients who underwent conventional laparoscopic rectal resection were allocated into a non-PPR group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion pelvic peritoneum reconstruction with barbed suture in laparoscopic rectal resection is safe and feasible for the treatment of rectal cancer, which can significantly reduce postoperative perineal-related complications.

Age and comorbidities do not affect short-term outcomes after laparoscopic rectal cancer resection in elderly patients. A multi-institutional cohort study in 287 patients

Postoperative complications and mortality rates after rectal cancer surgery are higher in elderly than in non-elderly patients. The aim of this study is to evaluate whether, like in open surgery, age and comorbidities affect postoperative outcomes limiting the benefits of a laparoscopic approach. Between April 2011 and July 2020, data of 287 patients with rectal cancer submitted to laparoscopic rectal resection from different institutions were collected in an electronic database and were categorized into two groups: < 75 years and ≥ 75 years of age. Perioperative data and short-term outcomes were compared between these groups. Risk factors for postoperative complications were determined on multivariate analysis, including age groups and previous comorbidities as variables. Seventy-seven elderly patients had both higher ASA scores (p < 0.001) and cardiovascular disease rates (p = 0.02) compared with 210 non-elderly patients. There were no significative differences between groups in terms of overall postoperative complications (p = 0.3), number of patients with complications (p = 0.2), length of stay (p = 0.2) and death during hospitalization (p = 0.9). The only independent variables correlated with postoperative morbidity were male gender (OR 2.56; 95% CI 1.53–3.68, p < 0.01) and low-medium localization of the tumor (OR 2.12; 75% CI 1.43–4.21, p < 0.01). Although older people are more frail patients, short-term postoperative outcomes in patients ≥ 75 years of age were similar to those of younger patients after laparoscopic surgery for rectal cancer. Elderly patients benefit from laparoscopic rectal resection as well as non-elderly patient, despite advanced age and comorbidities.