Laparoscopic Colon Surgery Dr. Shahram Nazari, MD SAGES,ELSA Consultant & Lecturer in Surgery, Department of General and Laparoscopic Surgery, Milad Hospital,

Laparoscopic Colon Laparoscopic Colon SurgerySurgery

Dr. Shahram Nazari, MDDr. Shahram Nazari, MDSAGES,ELSASAGES,ELSA

Consultant & Lecturer in Surgery, Department of Consultant & Lecturer in Surgery, Department of General and Laparoscopic Surgery, Milad Hospital, General and Laparoscopic Surgery, Milad Hospital,

Tehran, IranTehran, Iran [email protected]@yahoo.com

www.dr-nazari.comwww.dr-nazari.com

► In 1902 In 1902 KellingKelling reported the first reported the first successful endoscopic examination of the successful endoscopic examination of the abdominal cavity.abdominal cavity.

► A few years later A few years later JacobeusJacobeus advocated the advocated the use of this procedure in patients with use of this procedure in patients with ascites and for the early diagnosis of ascites and for the early diagnosis of malignant lesions.malignant lesions.

IntroductionIntroduction11

► Laparoscopy was initially limited to easy Laparoscopy was initially limited to easy procedures such as cholecystectomy or procedures such as cholecystectomy or appendectomy.appendectomy.

►Minimally invasive operations were aggressively Minimally invasive operations were aggressively developed in the 1990s. developed in the 1990s.

► Advanced laparoscopic techniques such as Advanced laparoscopic techniques such as antireflux surgery,Heller`s cardio myotomy, CBD antireflux surgery,Heller`s cardio myotomy, CBD explorations.explorations.

► Laparoscopy was proposed for colorectal surgery Laparoscopy was proposed for colorectal surgery as early as 1991.as early as 1991.

► The widespread use of laparoscopy for the The widespread use of laparoscopy for the diagnosis and surgical treatment of diseases of the diagnosis and surgical treatment of diseases of the abdomen and pelvis is continuously expanding the abdomen and pelvis is continuously expanding the scope of laparoscopic procedures.scope of laparoscopic procedures.

IntroductionIntroduction22

► The potential roles for The potential roles for laparoscopy in the laparoscopy in the treatment of colonic diseasestreatment of colonic diseases include include diagnosis, drainage, diversion, removal of the diagnosis, drainage, diversion, removal of the affected segment, and reconstruction of affected segment, and reconstruction of Hartmann’s procedure, and anastomosis.Hartmann’s procedure, and anastomosis.

► However, laparoscopic colorectal surgery However, laparoscopic colorectal surgery remains a remains a challengechallenge because in this because in this procedure the field of action is wider than in procedure the field of action is wider than in other advanced laparoscopic techniques.other advanced laparoscopic techniques.

► The place of laparoscopic-assisted colectomy The place of laparoscopic-assisted colectomy for colorectal carcinoma is for colorectal carcinoma is controversialcontroversial..

Benign (non-cancerous) Benign (non-cancerous) problems which may require problems which may require

surgery 1surgery 1►Adenomatous PolypsAdenomatous Polyps

►Diverticular DiseaseDiverticular Disease

Benign (non-cancerous) Benign (non-cancerous) problems which may require problems which may require

surgery 2surgery 2► Familial or Hereditary PolyposisFamilial or Hereditary Polyposis

► Inflammatory Bowel Disease Inflammatory Bowel Disease Crohn's ColitisCrohn's ColitisUlcerative ColitisUlcerative Colitis

Colon CancerColon Cancer

►Colon CancerColon Cancer

Specialized instruments used in laparoscopic surgery of the colon and

rectum.

Advantages of Laparoscopic Advantages of Laparoscopic Colon ResectionColon Resection

Reduced postoperative painReduced postoperative pain More rapid return of normal bowel functionMore rapid return of normal bowel function Faster return to solid foodFaster return to solid food Shorter hospital stayShorter hospital stay Faster return to everyday activitiesFaster return to everyday activities Improved cosmetic resultsImproved cosmetic results May result in reduced formation of scar tissue May result in reduced formation of scar tissue

inside the abdomeninside the abdomen

AimsAims of this study of this study

►To evaluate To evaluate the feasibilitythe feasibility of of laparoscopic colectomy.laparoscopic colectomy.

►To evaluate To evaluate the safetythe safety aspects of this aspects of this approach.approach.

MethodsMethods

►Between April 2005 and December 2006Between April 2005 and December 2006►10 consecutive patients underwent LCS 10 consecutive patients underwent LCS

in two non academic hospitals by the in two non academic hospitals by the author.author.

►There were 8 females and 2 males with There were 8 females and 2 males with a mean age of a mean age of 337.5 (range 22-7.5 (range 22-667) years. 7) years.

Indications for surgeryIndications for surgery

►Diverticulitis (1 patient)Diverticulitis (1 patient)►Adenocarcinoma (3 patients)Adenocarcinoma (3 patients)►Obstructing sigmoidocele Obstructing sigmoidocele

with prolapse (1 case) with prolapse (1 case) without prolapse (2 cases)without prolapse (2 cases)

►Dolichosigmoid (3 patients)Dolichosigmoid (3 patients)

Results Results 11

►8 females and 2 males8 females and 2 males►Mean age of Mean age of 337.5 (range 22-7.5 (range 22-667) years 7) years ►Mean operation time was 200 Min Mean operation time was 200 Min

(range, 160 - 290)(range, 160 - 290)►No conversionNo conversion►No anastomosis leakage No anastomosis leakage ►No post-operative death No post-operative death ►2 port site 2 port site herniahernia in one patient in one patient ►3 port site 3 port site infectionsinfections in 3 patients in 3 patients

Results Results 22

► Laparoscopic sigmoidectomy Laparoscopic sigmoidectomy in 5 cases in 5 cases --with intracorporeal stapler with with intracorporeal stapler with colorectalcolorectal

anastomosis in 4 cases anastomosis in 4 cases --extracorporealextracorporeal hand-sewn hand-sewn anastomosis in 1 caseanastomosis in 1 case

► Laparoscopic assisted right hemicolectomyLaparoscopic assisted right hemicolectomy (with extracorporeal hand-sewn anastomosis in (with extracorporeal hand-sewn anastomosis in 1 case)1 case)

► Laparoscopic assisted left hemicolectomyLaparoscopic assisted left hemicolectomy (with (with extracorporeal hand-sewn anastomosis in one extracorporeal hand-sewn anastomosis in one case)case)

► Rectopexy Rectopexy without sigmoid colon resection(3 without sigmoid colon resection(3 cases)cases)

DiscussionDiscussion►Recent advances in minimal access Recent advances in minimal access

surgery of the colon have made surgery of the colon have made laparoscopic or assisted colorectal laparoscopic or assisted colorectal resection an attractive resection an attractive alternative to alternative to open surgery open surgery ..

►Elective laparoscopic or assisted Elective laparoscopic or assisted colectomy may be feasible and safe. colectomy may be feasible and safe.

► In selective cases the complications are In selective cases the complications are fewfew. .

ComplicationsComplications

►Specifically attributed to the nature of Specifically attributed to the nature of disease:disease:

►Specifically attributed to the Specifically attributed to the laparoscopic technique:laparoscopic technique:

►Specifically attributed to the Specifically attributed to the instruments:instruments:

►Specifically attributed to the Surgeon Specifically attributed to the Surgeon (Learning Curve)(Learning Curve)