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LAPAROSCOPIC  COLON RESECTION - Anterior Approach Sandeep Malhotra, MD Scott Steinberg, MD George Ferzli, MD, FACS Profess...
Anterior Approach <ul><li>Patient supine </li></ul><ul><li>Position hand over sigmoid and rotate in semi-circle to place t...
Trocar Placement : Anterior Position
Anterior position   1 2 Trocar in inguinal crease cuts sigmoid
Repair - Anterior Position If proximal colon can be brought  through inguinal crease trocar  incision, tension free repair...
Anterior Approach
Anterior Approach
Laparoscopic Sigmoid Colectomy Ferzli G et al. (2000 – 2001) Unpublished Data 147 (110 – 279) 142 (98 – 216) OR Time 2.4 (...
Laparoscopic Versus Open Colectomy for Cancer
Colorectal Resection Laparoscopic vs. open resection for carcinoma RHC = Right hemicolectomy; Trans = Transverse; AR = Ant...
Colorectal Resection Laparoscopic vs. open resection for carcinoma Franklin ME et al, Dis Colon Rectum 1996;39:s35-s46 19....
Colorectal Resection Laparoscopic vs. open resection for carcinoma Santoro E et al, Hepato-Gastroenterology 1999; 46:900-9...
Colorectal Resection Laparoscopic vs. open resection for carcinoma Curet MJ et al, Surg Endosc (2000) 14: 1062-1066 1 6 4 ...
Long-Term Survival After Laparoscopic Colon Resection For Cancer <ul><li>Aim : To evaluate long-term survival after curati...
Long-Term Survival After Laparoscopic Colon Resection For Cancer Lap Open
Long-Term Survival After Laparoscopic Colon Resection For Cancer Lap Open – Nat. Ca. Database
Long-Term Survival After Laparoscopic Colon Resection For Cancer - Conclusions <ul><li>Laparoscopic colectomy for cancer i...
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Laparoscopic Colon Resection - Anterior Approach

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Transcript of "Laparoscopic Colon Resection - Anterior Approach"

  1. 1. LAPAROSCOPIC COLON RESECTION - Anterior Approach Sandeep Malhotra, MD Scott Steinberg, MD George Ferzli, MD, FACS Professor of Surgery, SUNY Downstate Health Science Center, Brooklyn, NY
  2. 2. Anterior Approach <ul><li>Patient supine </li></ul><ul><li>Position hand over sigmoid and rotate in semi-circle to place trocars (3) </li></ul>
  3. 3. Trocar Placement : Anterior Position
  4. 4. Anterior position 1 2 Trocar in inguinal crease cuts sigmoid
  5. 5. Repair - Anterior Position If proximal colon can be brought through inguinal crease trocar incision, tension free repair will be successful
  6. 6. Anterior Approach
  7. 7. Anterior Approach
  8. 8. Laparoscopic Sigmoid Colectomy Ferzli G et al. (2000 – 2001) Unpublished Data 147 (110 – 279) 142 (98 – 216) OR Time 2.4 (2 - 9) 2.2 (2 - 10) Hospital Stay 1 leak (re-op hartman) 1 hematoma flank, 1 re-op for SBO, 1 leak (cut.drainage) Complications 12 5 <ul><li>Carcinoma </li></ul>6 3 <ul><li>Polyp </li></ul>20 (4 abscess) 16 (2 abscess) <ul><li>Diverticulitis </li></ul>Indications: 35:3 23:1 Sex, M:F 46 (27 - 86) 48 (32 - 70) Age Anterior (38) Lateral (24) Total (n) = 62 pts
  9. 9. Laparoscopic Versus Open Colectomy for Cancer
  10. 10. Colorectal Resection Laparoscopic vs. open resection for carcinoma RHC = Right hemicolectomy; Trans = Transverse; AR = Anterior resection; Sig = Sigmoid; LAR = Low anterior resection; APR = Abdominoperineal resection Franklin ME et al, Dis Colon Rectum 1996;39:s35-s46
  11. 11. Colorectal Resection Laparoscopic vs. open resection for carcinoma Franklin ME et al, Dis Colon Rectum 1996;39:s35-s46 19.1% 13% Cumulative death and recurrence rates 5 years into the study (Stages I, II, and III) 22% 12.2% Recurrence rates 6% 0.5% Wound complications 450 150 Blood loss, mL 9 5.6 Hospitalization, days Open (n=224) Laparoscopic (n=192)
  12. 12. Colorectal Resection Laparoscopic vs. open resection for carcinoma Santoro E et al, Hepato-Gastroenterology 1999; 46:900-904 1 1 Liver+Peritoneum+ Trocar-site or scar 4 4 Liver+ Peritoneum 5 5 Multiple site metastases 1 1 Regional 4 2 Liver 5 3 Single site metastases 10 (23%) 8 (20%) Overall metastases 43 40 No. of cases (n) Open Lap. Follow-up
  13. 13. Colorectal Resection Laparoscopic vs. open resection for carcinoma Curet MJ et al, Surg Endosc (2000) 14: 1062-1066 1 6 4 Late death from cancer (mean follow-up 4.9 years) 12 10 11 Number of lymph nodes 32 26 26 Length of specimen (cm) 8, 100% 5, 28% 1, 5% Complications (n, %) 8 7.3 5.2 Length of stay (days) 7 5.8 4.1 Regular diet (days) 5 4.4 2.7 Clear liquids (days) 6 4 3 ICU stay (days) 683 407 284 Blood loss (mL) 242 138 210 Operating room time (min) Converted (n=7) Open (n=18) Lap (n=18) 1 1 0 Recurrence
  14. 14. Long-Term Survival After Laparoscopic Colon Resection For Cancer <ul><li>Aim : To evaluate long-term survival after curative, laparoscopic resection for colorectal cancer. </li></ul><ul><li>Design : Retrospective review of 102 consecutive patients with laparoscopic colon resection between 1991 and 1996 with 5-year follow-up. Comparison made to open colectomy at the same institution and National Cancer Database during similar time period. </li></ul>Lujan HJ et.al. Dis. of Colon and Rectum;45:491-405,April 2002
  15. 15. Long-Term Survival After Laparoscopic Colon Resection For Cancer Lap Open
  16. 16. Long-Term Survival After Laparoscopic Colon Resection For Cancer Lap Open – Nat. Ca. Database
  17. 17. Long-Term Survival After Laparoscopic Colon Resection For Cancer - Conclusions <ul><li>Laparoscopic colectomy for cancer is safe and feasible </li></ul><ul><li>5-year survival after laparoscopic colon resection for cancer is similar to survival after conventional surgery </li></ul><ul><li>Prospective randomized trials currently under way will likely confirm these results </li></ul>Lujan HJ et.al. Dis. of Colon and Rectum;45:491-405,April 2002
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