Laparoscopic Surgery For Colon Cancer Research Articles

Surgery: green light given for laparoscopic surgery for rectal cancer.

Randomized trial data support the use of laparoscopic surgery for colon cancer; however, such evidence was lacking for rectal cancer. Now, the COLOR II randomized trial gives minimally invasive resection of rectal cancer the 'green light', answering the question 'should laparoscopic surgery be used?' The new key question is 'who should be performing laparoscopic surgery for rectal cancer?'

A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery.

Laparoscopic colon and rectal cancer surgery is oncologically equivalent to open resection, but the impact of conversion is undetermined. The aim of this study was to assess the oncological outcome and predictive factors associated with conversion. A comprehensive search for published studies examining the associated factors and outcome of conversion from laparoscopic to open colorectal cancer resection was performed adhering to PRISMA (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Only randomized control trials and prospective studies were included. Each study was reviewed and the data extracted. Random effects methods were used to combine data. Fifteen studies, including 5293 patients, met the inclusion criteria. Of these 4391 patients had a completed laparoscopic resection and 902 were converted to an open resection. The average conversion rate of the studies was 17.9±10.1%. Meta-analysis showed completed laparoscopic surgery favoured lower 30-day mortality (OR 0.134, 95% CI 0.047-0.385, P<0.0001), lower long-term disease recurrence (OR 0.634, 95% CI 0.421-0.701, P<0.023) and lower overall mortality (OR 0.512, 95% CI 0.417-0.629, P<0.0001). Factors negatively associated with completion of laparoscopic surgery were male gender (P=0.011), rectal tumour (P=0.017), T3/T4 tumour (P=0.009) and node-positive disease (P=0.009). Completed laparoscopic surgery was also associated with a lower body mass index (BMI; mean difference -0.93kg/m(2) , P=0.004). The results suggest that conversion from laparoscopic to open colorectal cancer resection is influenced by patient and tumour characteristics and is associated with an adverse perioperative outcome. Although confounding factors such as advanced tumour stage and elevated BMI are present, unsuccessful laparoscopic surgery appears to be associated with an adverse long-term oncological outcome.

Severe cellulitis and abdominal wall emphysema following laparoscopic colonic surgery: A case report

Abdominal wall emphysema is a common complication of laparoscopic surgery. This condition is usually harmless; however, if an infection occurs, it can develop into a serious condition such as necrotizing fasciitis. We report a case of a 51-year-old woman suffering from severe cellulitis that spread from an area of abdominal wall emphysema after laparoscopic surgery for sigmoid colon cancer. Recognizing this complication, early diagnosis, and prompt treatment are cornerstones for successful management of this potentially fatal disease.

Water-enema multidetector computed tomography for planning surgery.

Water-enema multidetector computed tomography (WE-MDCT) is a technique for the localization and preoperative T- and N-stage assessments of colon cancer. It may be a useful tool for planning surgery. The primary aim of this study was to evaluate the diagnostic accuracy of WE-MDCT for T-staging and its ability to locate tumors for laparoscopy planning. The secondary aim was to assess reading reproducibility and diagnostic accuracy for the preoperative determination of N-stage. We performed a study to evaluate preoperative WE-MDCT for surgical planning in patients with symptomatic colon adenocarcinomas who underwent surgery between June 2010 and January 2014. A radiologist and a surgeon read the WE-MDCTs separately. Results were compared with colonoscopy and the surgical specimen. Seventy-one patients (42 men (59.1%); mean age 73.1 years (range 45 to 95)) were included. Seventy-six tumors were assessed. The intraclass correlation coefficient (ICC) for location as determined by surgery and that determined by WE-MDCT was 1, and the ICC for location between colonoscopy and WE-MDCT was 0.85 (95% CI 0.75-0.91). For T-stage determination, sensitivity was 96 and 94% and specificity 83 and 88% for readers 1 and 2, respectively. The T-stage assessment allowed for the programing of surgical access and showed good sensitivity and specificity for the assessment of invasion in adjacent organs. WE-MDCT is relatively easy to perform, and its results can be read effectively by radiologists and surgeons. WE-MDCT indicated the location of tumors perfectly and permitted a good determination of their T-stage. The technique is thus pertinent for the planning of laparoscopic surgery for colon cancer.

Laparoscopic versus open colorectal surgery for colon cancer: the effect of surgical trauma on the bacterial translocation. A prospective randomized study

BackgroundSeveral studies suggest that surgical manipulation of the intestine and increased intra-abdominal pressure promotes bacterial translocation (BT). This prospective randomized study has investigated the effect of surgery on BT in patients undergoing elective colectomy for colon cancer by comparing the laparoscopic with the open approach. MethodsOne hundred nineteen consecutive patients underwent colectomy for colon cancer: 59 cases underwent open resection and 60 cases underwent laparoscopic resection. For bacterial identification, tissue samples were taken from the liver, spleen, and mesenteric lymph nodes. ResultsThe incidence of BT increased in laparoscopic and open group after bowel mobilization (prior to ligation of the vascular pedicle), compared with the before mobilization (P < .05). There was not a statistically significant difference in BT value between the 2 groups. ConclusionBT increase was observed during the open and laparoscopic resection for colon cancer, without significant statistical difference between the 2 groups.

Complete laparoscopic sigmoid colectomy for obese patient with sigmoid colon cancer

Abstract (Clinical practice points) What is already known about this subject? After nearly 20 years of development, laparoscopic surgery for colon cancer has emerged as the standard procedure compared to open surgery with similar oncologic outcomes and superior perioperative results. Usually, an abdominal incision is required for anastomosis and specimen extraction for laparoscopic colon surgery. Recently, natural orifice specimen extraction (NOSE) and intracorporeal anastomosis have been proposed to improve the quality of laparoscopic colon resections. This approach can eliminate a larger abdominal incision other than that for trocar placement. However, intracorporeal anastomosis is the major challenge in laparoscopic surgery. Technique of delta-shaped anastomosis which was used for the gastric cancer surgery was reported firstly in 2002. and there was no report on the feasibility and safety of totally laparoscopic resection with delta-shaped anastomosis for colon cancer surgery till now. we describe this simple and safe technique of intracorporeally delta-shaped anastomosis in sigmoid colectomy combined with transvaginal extraction of the specimen. What are the new findings? Natural orifice specimen extraction and intracorporeal anastomosis have been proposed to improve the quality of laparoscopic colon resections. This case report demonstrates that the technical innovations of transvaginal specimen extraction and an intracorporeal delta-shaped anastomosis is considered a more feasible and safer procedure, and obesity does not adversely affect the outcomes of this technique with respect to postoperative recovery. How might it impact on clinical practice in the foreseeable future? This case report describes the feasibility, safety and shortterm outcome of an intracorporeal delta-shaped anastomosis technique for laparoscopic sigmoid colectomy combined with transvaginal extraction of the specimen in an obese patient. Our findings suggest that this technique is more feasible and safer for patients with sigmoid colon cancer than other natural orifice specimen extraction approaches and that obesity does not adversely affect the outcome of this technique with respect to postoperative recovery. We suggest that intracorporeal deltashaped anastomosis and transvaginal specimen extraction may be an appropriate technique for sigmoid colectomy without complications in suitable patients.

Cranially approached radical lymph node dissection around the middle colic vessels in laparoscopic colon cancer surgery.

Laparoscopic lymph node (LN) dissection around the middle colic vessels is technically demanding, thus raising controversy regarding the role of laparoscopic surgery for transverse colon cancer. We herein describe a cranial approach method to perform radical LN dissection around the middle colic vessels. The key characteristic of this approach is early division of middle colic vessels prior to mobilization of the colon. From April 2010 to September 2013, 27 patients with colon cancer received laparoscopic LN dissection around the middle colic vessels using this cranial approach. Their surgical and short-term outcomes were reviewed. The mean number of harvested LNs was 29 (range, 6-50). The mean operative time and intraoperative blood loss were 274 min (range, 160-362 min) and 42 mL (range, 3-247 mL), respectively. There were no serious intraoperative complications or conversions to open surgery. There were two patients with stage 0, 7 with stage I, 12 with stage II, and 6 with stage III. No recurrent case was observed with a median follow-up period of 30 months (range, 9-48 months). We consider this approach feasible and useful for radical LN dissection around the middle colic vessels during laparoscopic colon cancer surgery.

Laparoscopic surgery for colon cancer: quality requirements for (extended) right hemicolectomy

The current S3 guidelines on the surgical treatment of colorectal cancer note that with a suitable patient selection and expertise of the surgeon the same oncological results can be achieved laparoscopically as with the open procedure. This requires that the same quality requirements have to be provided for both methods. The most important quality parameters of right sided (extended) hemicolectomy are central ligation of the supplying arteries (ileocolic artery, right branch of the middle colic artery and middle colic artery) flush to the central origin of the vessel (superior mesenteric artery or middle colic artery) and the sharp dissection of the mesocolon without any preparation tears. The photographic documentation of the fresh surgical specimens for categorizing the preparation quality as well as to determine the pedicle of the vessel can capture this quality well and is also currently the best surrogate parameter to evaluate the oncological quality of the operation. At present, there are still considerable widespread deficits not only with the laparoscopic approach but also in open surgery which must be urgently fixed.

Mo1072 Optimizing the Utilization of Adjuvant Chemotherapy Following Surgical Resection of Colon Cancer: A Comparison of Laparoscopic Versus Open Approach

Purpose Previous research has demonstrated that laparoscopic approach to colon cancer resection is a safe and potentially beneficial alternative to open surgery. Open colon cancer surgery has higher complication rates than laparoscopic surgery, whichmay delay chemotherapy for stage-specific tumors. Omission or delay in chemotherapy is known to significantly impact overall survival. In this study, we examine the use of appropriate adjuvant chemotherapy following open and laparoscopic surgery for colon cancer in a large national cancer registry. Methods The National Cancer Data Base (NCDB) captures over 70% of cancer cases in the United States and provides detailed information on patient, tumor, and treatment characteristics. Cases of colon cancer undergoing segmental or hemicolectomy with node positive disease in the NCDB from 2010-2011 were included in the analysis. Primary outcomes were use of any adjuvant chemotherapy and use of adjuvant chemotherapy within 90 days of surgery. To adjust for non-random treatment selection, propensity adjustment with inverse probability weighting (IPW) was performed. Patient and tumor characteristics before and after IPW adjustment were compared. Weighted logistic regression after IPW was used to compare the association of laparoscopic and open surgery with the use of adjuvant chemotherapy. Results From 2010-2011, 19,531 patients with colon cancer and positive lymph nodes undergoing surgery were identified in the NCDB, with 12,088 patients (61.9%) undergoing open surgery and 7,443 (38.1%) treated laparoscopically. Patients undergoing open surgery tended to have more comorbidities, larger tumors, higher clinical T and N staging, and were more likely to be treated at community cancer programs (as opposed to comprehensive cancer centers or academic research programs); however, these differences were minimized after IPW adjustment (Table). Before IPW, rates of adjuvant chemotherapy use were 62.3% for patients after open surgical resection, compared to 70.6% after laparoscopic surgery (p<0.001). After IPW, odds ratio (OR) for adjuvant chemotherapy use was 1.27 (95% CI: 1.19-1.36) for laparoscopic versus open surgery, indicating that patients undergoing laparoscopic surgery were more likely to receive adjuvant therapy. For adjuvant chemotherapy within 90 days of surgery, OR was 1.28 (1.20-1.36), again favoring a laparoscopic approach (Figure). Conclusion Patients undergoing laparoscopic surgery for pathologic stage III colon cancer had higher rates of adjuvant chemotherapy use and lower rates of delay in chemotherapy initiation compared to those treated with open procedures, likely due to reduced complications from laparoscopic surgery. Further research will need to examine long-term outcomes in this population in order to understand the impact on disease recurrence and long-term survival. Table. Preoperative patient characteristics by surgical approach before and after IPW adjustment

The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: A case-matched study of 152 patients

Despite the increasing prevalence of obesity and colonic diseases, the impact of obesity on short-term and oncologic outcomes of laparoscopic colorectal surgery still remains unclear. Seventy-six consecutive obese patients with body mass index (BMI) ≥30kg/m(2) who underwent laparoscopic colectomy were matched with 76 nonobese patients with BMI <30kg/m(2). Perioperative parameters and oncologic outcomes were analyzed in the two groups. Obesity was associated with greater operative time (obese vs nonobese, 182±59 vs 157±55min, P=.0084) and multivariate analysis identified BMI (hazard ratio 2.11, 95% confidence interval 0.64-3.56, P=.0049) as an independent predicting factor for operative time together with cancer location (hazard ratio 28.6, 95% confidence interval 14.62-42.51, P<.0001). Obesity had no adverse influence on overall morbidity (25 vs 21%, P=.563), however, or postoperative duration of stay (median 6.0 vs 5.5days, P=.22). Furthermore, the rate of conversion to open procedure was similar between the two groups (9 vs 9%, P>.99). Regarding oncologic outcomes, there was no statistical difference in overall and disease-free survival between the two groups (5-year overall survival rate 86 vs 89%, P=.72, 5-year disease survival rate 70 vs 77%, P=.70). Laparoscopic colonic resection, when performed for selected patients, appears to be a safe and reasonable option in obese patients with colon cancer resulting in similar short-term and oncologic outcomes as nonobese patients.

Laparoscopic surgery for colon cancer: a review of the fascial composition of the abdominal cavity

Laparoscopic surgery has generally been performed for digestive diseases. Many patients with colon cancer undergo laparoscopic procedures. The outcomes of laparoscopic colectomy and open colectomy are the same in terms of the long-time survival. It is important to dissect the embryological plane to harvest the lymph nodes and to avoid bleeding during colon cancer surgery. To date, descriptions of the anatomy of the fascial composition have mainly involved observations unrelated to fundamental embryological concepts, causing confusion regarding the explanations of the surgical procedures, with various vocabularies used without definitions. We therefore examined the fascia of the abdominal space using a fascia concept based on clinical anatomy and embryology. Mobilization of the bilateral sides of the colon involves dissection between the fusion fascia of Toldt and the deep subperitoneal fascia. It is important to understand that the right fusion fascia of Toldt is divided into the posterior pancreatic fascia of Treitz dorsally and the anterior pancreatic fascia ventrally at the second portion of the duodenum. A comprehensive understanding of fascia composition between the stomach and transverse colon is necessary for dissecting the splenic flexure of the colon. As a result of these considerations of the fascia, more accurate surgical procedures can be performed for the excision of colon cancer.

Long-Term Outcomes of Laparoscopic Surgery for Advanced Transverse Colon Cancer

BackgroundThe role of laparoscopic surgery for advanced transverse colon cancer (TCC) remains controversial, especially in terms of long-term oncologic outcomes. MethodsThis retrospective cohort study enrolled 157 consecutive patients who underwent curable resections for advanced TCC between January 2002 and June 2011 (laparoscopic-assisted colectomy (LAC), n = 74; open colectomy (OC), n = 83). Short-term outcomes and oncologic long-term outcomes were compared between the two groups. ResultsCompared to the OC group, patients in the LAC group had less blood loss (LAC vs. OC, 79.6±70.3 vs. 158.4±89.3 ml, p < 0.001), faster return of bowel function (2.6±0.7 vs. 3.8±0.8 days, p < 0.001), and shorter postoperative hospital stay (10.3±3.7 vs. 12.6±6.0 days, p = 0.007). Conversions were required in four (5.4 %) patients. Rates of short-term complication, mortality, and long-term complication were comparable between the two groups. The median follow-up time was 54 (26–106) months in the LAC group and 58 (29–113) months in the OC group (p = 0.407). There were no statistical differences in the rates of 5-year overall survival (73.6 vs. 71.1 %, p = 0.397) and 5-year disease-free survival (70.5 vs. 66.7 %, p = 0.501) between the two groups. ConclusionsLaparoscopic surgery for advanced TCC yield short-term benefits while achieving equivalent long-term oncologic outcomes.

Effect of previous abdominal surgery on short-term outcomes following laparoscopic colorectal surgery.

653 Background: The impact of previous abdominal surgeries on the need for conversion to open surgery and on short-term outcomes during/after laparoscopic colorectal surgery was retrospectively investigated. This retrospective cohort study was conducted from May 2004 through October 2012. This study was conducted at Tokushima University Hospital and Ehime Prefectural Central Hospital. Methods: A total of 145 consecutive patients who had undergone laparoscopic resection of the sigmoid colon and upper rectum were classified as not having previous abdominal surgery (NPAS group, n = 123) or as having previous abdominal surgery (PAS group, n = 22). Short-term outcomes were assessed between the two groups. Results: The population of previous abdominal surgery consisted of 6 appendectomy, 3 gastrectomy for gastric ulcer, 2 nephrectomy, 2 peritonitis and 11 others (2 duplication). There were no significant differences in age, gender, BMI, tumor location, tumor size, Stage, operating time, blood loss and number of lymph node harvest between the two groups. The conversion to open surgery was performed in 1 patient (4.5%) in the PAS group and 6 patients (4.9%) in the NPAS group. The intraoperative inadvertent enterotomy occurred in 1 patient in the NPAS group. There was no difference in postoperative morbility between the two groups. In the NPAS group, anastomotic leakage was observed in 3 cases. Ileus was observed in one case in the NPAS and none in the PAS. Postoperative hospital stay was 14 days in the PAS group and 16 days in the NPAS group. Conclusions: Short-term outcomes following laparoscopic surgery for sigmoid colon and upper rectal cancer with previous abdominal surgery are acceptable.

Conversion-to-open of laparoscopic surgery for rectal cancer: Impact on outcomes

Low anterior resection of the rectum (LARR) with total mesorectal excision (TME) for rectal cancer by laparoscopy is considered very technically demanding, particularly at the stages of dissection around the mesorectal fascia deep into the pelvis and transection of the rectum distally to the tumour. These technical difficulties translate to an increased conversion-to-open rate, higher than that seen after laparoscopic surgery for colon cancer. Conversion-to-open is considered as a technical limitation of the approach rather than a complication. There are reports claiming that converted cases are associated with higher morbidity rates than the laparoscopically completed. However, a review of the published articles indicates that conversion-to-open shows similar overall morbidity and mortality rates to those seen in the laparoscopically completed LARR-TME cases, and only duration of surgery is longer and wound infection rate is higher in the former group. Similarly, the overall oncological outcomes, namely local recurrence, distant metastasis and overall survival rates, are similar between the two groups.

Improving the outcomes in oncological colorectal surgery.

During the last several decades, colorectal cancer surgery has experienced some major perioperative improvements. Preoperative risk-assessment of nutrition, frailty, and sarcopenia followed by interventions for patient optimization or an adapted surgical strategy, contributed to improved postoperative outcomes. Enhanced recovery programs or fast-track surgery also resulted in reduced length of hospital stay and overall complications without affecting patient safety. After an initially indecisive start due to uncertainty about oncological safety, the most significant improvement in intraoperative care was the introduction of laparoscopy. Laparoscopic surgery for colon and rectal cancer is associated with better short-term outcomes, whereas long-term outcomes regarding survival and recurrence rates are comparable. Nevertheless, long-term results in rectal surgery remain to be seen. Early recognition of anastomotic leakage remains a challenge, though multiple improvements have allowed better management of this complication.

The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer

Although obesity is considered as a risk factor for postoperative morbidity in abdominal surgery, its effect on the outcomes of laparoscopic-assisted colectomy (LAC) is still unclear. The technical difficulty and risk factor for postoperative complication in LAC are thought to be influenced by visceral obesity. The aim of this prospective study was to evaluate the impact of visceral fat on the surgical outcomes of LAC. Between April 2005 and December 2010, consecutive patients with preoperatively diagnosed colon cancer, excluding medium and low rectal cancer, who underwent LAC, were enrolled. Their visceral fat area (VFA) and body mass index (BMI) were prospectively collected. The VFA was assessed by Fat Scan software. The patients were classified into two groups as follows: VFA nonobese with VFA <100 cm(2) (VNO) and VFA obese with VFA ≧100 cm(2) (VO). The predictive factors for surgical complications of LAC were evaluated by univariate and logistic regression analyses. A total of 338 consecutive patients were enrolled in this study. Of the 338 patients, 194 (57.4 %) and 138 (42.6 %) were classified into the VNO and VO groups, respectively. Logistic regression analysis showed that high BMI (≧25 kg/m(2)) and VO independently predicted the incidence of overall postoperative complications (p = 0.040 and 0.007, respectively). VO was more highly related to the incidence of overall postoperative complications, anastomotic leakage (p = 0.021), and surgical site infection (SSI) (p = 0.013) than high BMI. VFA is a more useful parameter than BMI in predicting surgical outcomes after LAC.

Laparoscopic surgery for rectal cancer: Current status and future perspective

Although laparoscopic surgery for colon cancer is accepted in the treatment guidelines, the laparoscopic approach for rectal cancer is recommended only in clinical trials. Thus far, several trials have shown favorable short-term results such as early recovery and short hospital stay, but long-term results remain a critical concern for laparoscopic rectal cancer surgery. To date, no randomized control trials have shown an increased local recurrence after laparoscopic surgery for rectal cancer. Additionally, according to previous studies, open conversion, which is more frequent in laparoscopic rectal surgery than in laparoscopic colon surgery, may affect short-term and long-term survival. The evidence on male sexual function has been contradictory. Long-term results from ongoing multicenter trials will be available within several years. Based on accumulated evidence from well-organized clinical trials, laparoscopic surgery will likely be accepted as a treatment choice for rectal cancer. In the future, extended laparoscopic rectal surgery might be feasible for additional procedures such as laparoscopic lateral pelvic lymph node dissection and laparoscopic total pelvic exenteration for rectal cancer invading the adjacent pelvic organ.

Single-incision Laparoscopic Surgery for Colon and Rectal Cancer

Single-incision laparoscopic surgery seems destined to take its place in the evolution of minimally invasive surgery. Although isolated cases have been reported in the literature, no series has yet been published on the use of this approach to treat colorectal cancer. We describe the surgical technique and perioperative outcomes of this approach in 15 patients diagnosed for colorectal cancer. We have used several devices to gain transumbilical access to the abdominal cavity, usually working with 3 cannulae to insert the instruments. We used a 5 mm endograsper, and articulated rotating (roticulating) endoscissors and endodissector to assist dissection. Vascular control and section of the rectum were performed using roticulating endostaplers. We combined the use of curved and straight instruments as required for each step during surgery. The dissection technique performed was the same as the one we normally use in conventional laparoscopy. Specimens were extracted through the umbilical incision. The most commonly performed procedure was sigmoidectomy (n=7), followed by high anterior resection of the rectum (n=5). The mean surgical time was 185±44.9 minutes. The mean hospital stay was 6.2±4.7 days. Three cases (20%) were converted to conventional laparoscopy. Surgery was curative in all of the patients. Single-access transumbilical laparoscopic surgery is feasible and safe for treating colorectal carcinoma when performed by surgeons with ample experience in laparoscopic colorectal resection. Further studies are needed to determine the advantages and drawbacks of this procedure.

Three-dimensional Computed Tomography for Analyzing the Vascular Anatomy in Laparoscopic Surgery for Right-sided Colon Cancer

The mesenteric vessels have many branching patterns. This study clarified the anatomic relationship between the superior mesenteric vein (SMV), the right colic artery (RCA), and the ileocolic artery (ICA) using 3-dimensional computed tomography (3D-CT). The relationship between the RCA and the right colic vein (RCV) was also examined. Between April 2006 and July 2011, all patients with colorectal cancer underwent multidetector computed tomography (MDCT) before laparoscopic surgery. The 100 most recent consecutive cases were analyzed. 3D-CT images were made by combining arterial angiography, venous angiography, colonography, tumor, lymph node, and duodenal images. The RCA branched from the SMA in 37 cases (37%); of these, 21 had an ICA that crossed anterior to the SMV and 16 had an ICA that crossed posterior. When the ICA crossed anterior to the SMV, all had an RCA that crossed anterior to the SMV, and no posterior RCA was seen. Furthermore, the RCV joined the SMV in 10 cases (27%) and the gastrocolic trunk in 27 cases (73%). Our study clarified the anatomic variety of the vessels in right-sided colon cancer. Preoperative 3D-CT is useful for understanding the anatomy to ensure a safe, precise operation.

Effectiveness of the EnSealTMSystem in Colorectal Cancer Surgery: A Pilot Randomized Study for Comparison with LigaSureTM

Purpose: Use of bipolar electocoagulation devices becomes popular in the laparoscopic surgical field. However, several studies comparing energy-based devices for use in performance of mechanical sealing and cutting techniques have reported various results. The aim of this study was to evaluate feasibility and efficacy of new commercially available bipolar electocoagulation devices: EnSeal™ device (Ethicon Endo-Surgery, Cincinnati, OH, USA) by comparison with LigaSure™ atlas 5 ㎜ (COVIDIEN, Boulder, CO, USA), for use in performance of coagulation and cutting techniques during performance of laparoscopic colorectal cancer surgery. Methods: Between June 2010 and February 2011, 50 consecutive patients who underwent curative laparoscopic surgery for right colon cancer or rectal cancer were enrolled. Time and number of device activations were compared during omentectomy in cases of right colectomy and mesorectal trimming procedure in cases of anterior resection. Pathologic data and short-term clinical outcomes were also compared. Results: No significant differences in terms of clinicopathologic comparison were observed between the EnSeal and LigaSure groups. No significant difference in mean operative time (207.6±45.3 vs. 198.9±57.2; p=0.558), mean time of omentectomy (11.0±4.5 vs. 12.6±8.6; p=0.293), mean time of m esorectal trimming (18.6±10.0 vs. 16.1±6.9; p=0.418), mean number of device activations during omentectomy (43.5±10.2 vs. 51.6±39.2; p=0.586), and mean number of device activations during performance of mesorectal trimming (44.8±22.3 vs. 49.1±23.7; p=0.597) were observed between the two groups. Conclusion: Bipolar electocoagulation devices were adapted for use in laparoscopic surgery, resulting in reduced operative time and blood loss. EnSeal™ Device and LigaSure™ atlas 5 ㎜ were useful during performance of sealing and cutting techniques in laparoscopic colorectal cancer surgery.