History and development trend of minimally invasive surgery for colorectal cancer in China

Abstract

With the development in past 20 years, the utilization of the laparoscopic surgery, which is the main trend in minimally invasive surgery for colorectal cancer, has tremendously changed. Minimally invasive surgery for colorectal cancer is now at a high level platform after going through the exploration at the very beginning and rapid development in the period of standardizing and promoting the regulations. Nowadays, the unique advantage that the laparoscopy owns is high definition and enlargement of the image, along with the establishment of the key note in series of laparoscopic complete mesocolic excision and the improvement of surgical instruments and methods make the operation skills accurate and normative in exploration of correct plane, high ligation of vessels and protection of nerve during the lymph node dissection of colorectal surgery. Currently, the most common procedure widely used in reconstruction of gastrointestinal(GI) tract is still laparoscopy-assisted approach. The frequent reconstruction of GI tract in rectal cancer surgery is double stapling technique, coloanal anastomosis by hand-sewn technique and the laparoscopic reconstruction of GI tract based on NOSE. At present, the most reconstructions of GI tract, including reconstruction by instrument and by hand-sewn are operated extracorporeally by pulling out the colon through the small incision, which is used to extract specimen. Although compared with the traditional reconstruction of GI tract, the complete laparoscopic excision has the advantage that the incision is smaller, it is more expensive. The preference approach of laparoscopic surgery is mainly medial approach, but with further understanding of CME, TME and the basic of medial approach, the new approaches like total medial approach, hybrid medial approach and caudal approach applied in right hemicolectomy and cephalad medial approach applied in rectal cancer have derived. As the introduction of NOTES, transanal TME and transanal transabdominal TME emerged but the experience is still primitive. Now, the focus points about the surgical operation platform relatively concentrate on 3D laparoscopic surgery and robotic surgery, while about the surgical techniques, the minimally invasive surgery techniques which are well developed in recent years are single incision laparoscopy and combined endoscopy-laparoscopic surgery, etc. When we are confident about the future of laparoscopic gastrointestinal surgery, it is necessary for us to slow down and think some questions seriously. What is the hot-point and challenge we need to focus on? What aspect is the innovation needed? With the help of rapidly developed technology, the new round overturning revolution in minimally invasive surgery techniques perhaps is going to emerge.