Laparoscopic Colon Resection Research Articles

Australasian Laparoscopic Colon Cancer Study shows that elderly patients may benefit from lower postoperative complication rates following laparoscopic versus open resection

A retrospective analysis of age-related postoperative morbidity in the Australia and New Zealand prospective randomized controlled trial comparing laparoscopic and open resection for right- and left-sided colonic cancer is presented. A total of 592 eligible patients were entered and studied from 1998 to 2005. Data from 294 patients who underwent laparoscopic and 298 who had open colonic resection were analysed; 266 patients were aged less than 70 years and 326 were 70 years or older (mean(s.d.) 70.3(11.0) years). Forty-three laparoscopic operations (14.6 per cent) were converted to an open procedure. Fewer complications were reported for intention-to-treat laparoscopic resections compared with open procedures (P = 0.002), owing primarily to a lower rate in patients aged 70 years or more (P = 0.002). Fewer patients in the laparoscopic group experienced any complication (P = 0.035), especially patients aged 70 years or above (P = 0.019). Treatment choices for colonic cancer depend principally upon disease-free survival; however, patients aged 70 years or over should have rigorous preoperative investigation to avoid conversion and should be considered for laparoscopic colonic resection. NCT00202111 (http://www.clinicaltrials.gov).

Laparoscopic resection with intracorporeal anastomosis for colon carcinoma located in the splenic flexure

Treatment of splenic flexure (SF) colon cancer is not standardized. A laparoscopic approach is considered a challenging procedure. This review examines a single-institution experience with laparoscopic colon resection for cancer of the SF. Intraoperative, pathologic, and postoperative data of patients who underwent laparoscopic SF resection were reviewed to assess for oncologic safety as well as early- and medium-term outcomes. Between September 2004 and January 2009, laparoscopic SF resection was performed for 15 patients with SF. Two cases of conversion were reported, and for three patients, colonic resection was robot assisted. In all cases, the anastomosis was completed intracorporeally. The distal margin was 3.8 +/- 2.5 cm, and the proximal margin was 7.8 +/- 3.7 cm from the tumor site. The mean number of harvested nodes was 9.2 +/- 5.3. The mean operative time was 183.6 +/- 45 min, and the blood loss was 98 +/- 33 ml. No major morbidity was recorded. Laparoscopic partial resection seems to be feasible and safe for the treatment of early-stage and locally advanced SF cancer.

Laparoscopic colectomy for transverse colon carcinoma

Laparoscopic resection of transverse colon carcinoma is technically demanding and was excluded from most of the large trials of laparoscopic colectomy. The aim of this study was to assess the safety, feasibility, and outcome of laparoscopic resection of carcinoma of the transverse colon. A retrospective review was performed to identify patients who underwent laparoscopic resection of transverse colon carcinoma. These patients were compared to patients who had laparoscopic resection for right and sigmoid colon carcinoma. In addition, they were compared to a historical series of patients who underwent open resection for transverse colon cancer. A total of 22 patients underwent laparoscopic resection for transverse colon carcinoma. Sixty-eight patients operated for right colon cancer and 64 operated for sigmoid colon cancer served as comparison groups. Twenty-four patients were identified for the historical open group. Intraoperative complications occurred in 4.5% of patients with transverse colon cancer compared to 5.9% (P = 1.0) and 7.8% (P = 1.0) of patients with right and sigmoid colon cancer, respectively. The early postoperative complication rate was 45, 50 (P = 1.0), and 37.5% (P = 0.22) in the three groups, respectively. Conversion was required in 1 (5%) patient in the laparoscopic transverse colon group. The conversion rate and late complications were not significantly different in the three groups. There was no significant difference in the number of lymph nodes harvested in the laparoscopic and open groups. Operative time was significantly longer in the laparoscopic transverse colectomy group when compared to all other groups (P = 0.001, 0.008, and <0.001 compared to right, sigmoid, and open transverse colectomy, respectively). The results of laparoscopic colon resection for transverse colon carcinoma are comparable to the results of laparoscopic resection of right or sigmoid colon cancer and open resection of transverse colon carcinoma. These results suggest that laparoscopic resection of transverse colon carcinoma is safe and feasible.

Laparoscopic anterior resection for rectosigmoid cancer: Patient outcomes after implementation of a clinical pathway

Introduction: A clinical pathway designed for a single type of laparoscopic colorectal surgery for cancer might be helpful in decreasing complication rates and total hospital costs. It has been reported to be effective in reducing costs and shortening length of hospital stays in many situations such as laparoscopic cholecystectomy, colon resection, total colectomy, and gastrointestinal bleeding, as well as when caring for patients in the intensive care unit. Materials and Methods: A clinical pathway, including surgical details and perioperative management, for patients undergoing laparoscopic anterior resection for rectosigmoid cancer was designed and implemented. From January 2003 to December 2006, it was applied to 80 patients. Results: The average length of a hospital stay for these patients was 9.06 d. The mean hospital stay and total cost decreased year by year. The overall complication rate was 8.75% without perioperative mortality, and 47.5% of patients with underlying diseases were treated safely. Discussion: Laparoscopic anterior resection for rectosigmoid cancer, with curative or palliative intent, was safe after standardization of surgical details and perioperative management. The total hospital costs for each patient was predictable and decreased year by year.

Diverticulitis or Cancer? That is the Question

Purpose: Introduction: Isolated diverticulitis is often known to mimic an inflammatory polyp or malignancy. Our patient is a 68 year old man who was found to have a suspicious appearing lesion arising in a diverticular pouch. This case represents the risk of endoscopic removal and appropriate conservative management with antibiotic treatment and laparoscopic removal of the lesion. Case Presentation: During a screening colonoscopy, our patient was found to have a 1.5 cm erythematous fungating lesion located in the sigmoid colon, within a diverticular pouch. The lesion was surrounded by multiple diverticuli. The site was marked with Spot ink for presumptive diagnosis of malignancy. Biopsies showed inflammatory changes and negative for malignancy. He denies abdominal pain, blood in the stool, and change in bowel habits, weight loss or fever. He denies any family history of colon cancer or polyps. Physical exam was unremarkable. His hemoglobin and MCV were within normal limits. The patient was empirically treated for diverticulitis with oral ciprofloxacin and metronidazole for 2 weeks. A colonoscopy was repeated in 2 months. The previously marked location was identified and there was significant improvement in erythema. However, the mucosa appeared multilobulated and suspicious for malignancy. This area was located in a diverticular pouch making endoscopic removal of the lesion high risk. Patient underwent laparoscopic resection of the affected colonic segment, which showed polypoid granulation tissue/inflammatory pseudopolyp arising in an inflamed diverticulum. Discussion: The prevalence of diverticulosis increases with age. By age 85, 65% of the population has diverticulosis. Most patients are asymptomatic (70%), however 15 to 25 percent develop diverticulitis, and 5 to 15 percent develop diverticular bleeding. Up to 30 percent of patients with uncomplicated diverticulitis require surgical intervention during the initial attack. Surgery has generally been advised after a first attack of complicated diverticulitis or after two or more episodes of uncomplicated diverticulitis. When compared to open sigmoid resection, laparoscopic colonic resection is associated with shorter recovery time. A laparascopic approach appears to be best suited for patients in whom the episode of acute diverticulitis has resolved and in patients with Hinchey classification stage I or II disease. Inflammation of a diverticulum can have a similar appearance to an inflammatory polyp or malignancy. Endoscopic removal of such lesions can lead to bowel perforation. Antibiotic treatment with or without laparoscopic removal should be recommended.

Mentoring and telementoring leads to effective incorporation of laparoscopic colon surgery

A community surgery group was reviewed for 1 year after completion of a laparoscopic colon surgery mentoring program. A formal mentoring protocol had been established between a university center and two surgeons at a community hospital. Over 18 months, concluding August 2007, surgeons were mentored and telementored through 20 laparoscopic colon resections in their local setting. Surgeons tracked their cases for a further 12 months after the mentoring. From September 2007 to August 2008, 30 colon resections were performed. Three of these resections (1 laparoscopic sigmoid colectomy for fistula and 2 laparoscopic subtotal colectomies) were mentored and telementored as advanced procedures. Of the remaining 27 resections, 15 (56%) were laparoscopic procedures including 9 right and 5 sigmoid colectomies as well as 1 subtotal colectomy. The 15 laparascopic colon resections were performed for cancer (n = 6), polyps (n = 5), diverticular disease (n = 2), Crohn's disease (n = 1), and colonic inertia (n = 1). Five cases were converted to open surgery (33%) due to adhesions (n = 3), unclear anatomy (n = 1), and equipment failure (n = 1). The mean number of lymph nodes in the cancer cases was 15.3 + or - 3.8. Minor postoperative complications occurred in seven cases (47%), three of which involved conversions. These complications included ileus (n = 4), wound abscess (n = 2), cardiac arrhythmia (n = 1), anastomotic bleed (n = 1), and abscess (n = 1). The patients selected for open surgery consisted of seven right and three sigmoid colectomies as well as a splenic flexure resection and a dual resection. The rationale for these open surgeries were transverse colon cancer (n = 4), medical comorbidity (n = 3), colovesicle fistulas (n = 2), rectal lesion (n = 2), and carcinoid tumor (n = 1). The laparoscopic patients were younger (58.2 + or - 13.2 vs 73.8 + or - 10.6 years; P = 0.003), had longer operating times (124 + or - 28 vs 94 + or - 38 min; P = 0.026), and a shorter median hospital stay (3 vs 7 days; P = 0.006). The laparoscopic operating time improved over the mentoring experience (124 + or - 28 vs 150 + or - 43 min; P = 0.046). The 1-year follow-up evaluation after a longitudinal mentoring program demonstrates excellent incorporation of laparoscopic colon surgery into a community practice with appropriate case selection, quality cancer surgery, and a moderate conversion rate.

Laparoscopic versus open right hemicolectomy: a comparison of short-term outcomes

The laparoscopic approach is increasingly becoming the gold standard for colorectal resections. While laparoscopic surgery of the left colon and rectum has been evaluated in many studies, laparoscopic resection of the right colon has not been as widely examined. The aim of this study was to examine the short-term outcomes after laparoscopic right hemicolectomies and to determine if they were superior when compared with those after open resection. Consecutive cases of laparoscopic right hemicolectomies performed between May 2005 and December 2007, in the Department of Colorectal Surgery, Singapore General Hospital, were compared with a matched series of patients who underwent open surgery. From a total of 37 laparoscopic cases, 36 patients successfully underwent laparoscopic right hemicolectomies. There was one conversion, giving a conversion rate of 2.7%. These 37 patients were compared with 40 patients who underwent open right hemicolectomies. The laparoscopic arm was characterised by shorter length of incisions (5.7 vs. 11.2 cm, p < 0.001) but longer operating times (110.8 vs. 71.6 min, p < 0.001). Mean number of lymph nodes harvested and length of proximal and distal margins were similar in both groups. There were also no significant differences between the groups in terms of narcotic use, recovery of bowel function, length of stay, post-operative morbidity and 30-day mortality. Laparoscopic right hemicolectomies are as feasible and safe as the open technique. They confer improved cosmesis with smaller incisions but at the expense of longer operating time.

Effect of Prednisolone on Local and Systemic Response in Laparoscopic vs. Open Colon Surgery

This study was designed to assess whether preoperative, short-term, intravenously administered high doses of methylprednisolone (30 mg/kg 90 minutes before surgery) influence local and systemic biohumoral responses in patients undergoing laparoscopic or open resection of colon cancer. Fifty-two patients who were candidates for curative colon resection were randomly assigned to laparoscopic or open surgery and, in a double-blind design, assigned to receive methylprednisolone (n = 26) or placebo (n = 26). Pulmonary function, postoperative pain, C-reactive protein, interleukins 6 and 8, and tumor necrosis factor alpha were analyzed, as was patient outcome. The steroid and placebo groups were well balanced for preoperative variables, as were the subgroups of patients who underwent laparoscopic (methylprednisolone, n = 13; placebo, n = 13) and open surgery (methylprednisolone, n = 13; placebo, n = 13). No adverse events related to steroid administration occurred. In the methylprednisolone groups, significant improvement in pulmonary performance (P = 0.01), pain control (P = 0.001), and length of stay (P = 0.03) were observed independent of the surgical technique. No differences in morbidity or anastomotic leak rate were observed among groups. Preoperative administration of methylprednisolone in colon cancer patients may improve pulmonary performance and postoperative pain, and shorten length of stay regardless of the surgical technique used (laparoscopy, open colon resection).

Support for the Selective Approach to Splenic Flexure Mobilisation

I have read with interest the argument for and against routine mobilisation of the splenic flexure in anterior resection for cancer. In our practice, the decision to mobilise the splenic flexure for left colonic or anterior resections is made easy; most of our patients (females more than males) have redundant left and sigmoid colons and the incidence of diverticular disease is rare. After division of the inferior mesenteric artery just distal to the left colic artery, the colon can be brought down to the pelvis without tension or compromised vascularity. Only on some rare occasions was the mobilisation deemed necessary to avoid tension at the anastomotic site. What was used to be practiced in open surgery is now translated even more precisely and efficiently during laparoscopic colonic resection. Based on this, I totally support (at least in our population) the selective approach to splenic flexure mobilisation which was advocated and argued for by Kennedy and Jenkins.

Conversion of laparoscopic colon resection does not affect survival in colon cancer

Diseases of the Colon & Rectum: May 2009 - Volume 52 - Issue 5 - p 1038 doi: 10.1097/01.dcr.0000345784.30463.e6

Emerging Role of Laparoscopic and Robotic Surgery for Rectal Cancers

The surgical management of rectal cancers is in a rapid phase of evolution that will increasingly deploy minimally invasive surgical (MIS) techniques. In this issue of Annals of Surgical Oncology are two articles about MIS approaches for rectal cancer, one comparing open versus laparoscopic proctectomy and the other comparing laparoscopic versus robotic approaches. These articles offer an opportunity to encourage the systematic validation of these technologies through clinical trials as they are increasingly adopted for colorectal surgery. Over the past decade, urologists have made great strides in implementing robotic surgery for pelvic procedures, although the surgical oncology and colorectal surgery communities have not yet embraced this technology at the same pace. For example, in 2007, approximately 50,000 radical prostatectomies were performed with the Da Vinci robot system in the United States, or approximately 60% of radical prostatectomies. In general, the reported results of robotic prostatectomy demonstrated less blood loss and shorter length of hospital stay; although the potency and continence rates were comparable, a trend was noted toward a faster return of functional outcomes. The gynecological community has also started to use the robotic system, which has shown similar results to those described by urologists for prostatectomy. That is, compared with open or laparoscopic techniques, robotic surgery for radical hysterectomy resulted in less blood loss, fewer postoperative complications, and shorter length of stay. Last year, Mattias Soop and Heidi Nelson, in an editorial published in Annals of Surgical Oncology, wrote, ‘‘we believe that the cumulative literature now supports an equipoise on short term advantages and long-term oncologic outcomes (for laparoscopic proctectomy for cancer), making the case for large prospective randomized trials.’’ Since the COST study group published its results in 2004 showing equivalence in oncologic outcomes between open and laparoscopic resection of colon cancer, the use of laparoscopic techniques for colon cancer has become popular and has now expanded to include rectal cancer patients. The data for rectal cancer is still being generated, but the randomized Conventional Versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC trial), as well as several retrospective studies, demonstrate that the use of laparoscopic techniques has at least equivalent oncologic outcomes compared with an open laparotomy approach. For example, in this issue of Annals of Surgical Oncology is a multivariate analysis of 421 consecutive patients with stage II and stage III rectal cancer conducted by Law and colleagues who retrospectively compared outcomes of open versus laparoscopic resection. Laparoscopic resection was associated with significantly less blood loss and shorter hospital stay and was one of the independent significant factors associated with better survival (P = .03, hazard ratio .558, 95% confidence interval .339–.969). Ng and colleagues from Hong Kong reported last year in Annals of Surgical Oncology the preliminary results of a randomized trial comparing open versus laparoscopic abdominoperineal resection in 99 rectal cancer patients with a follow-up of 90 months. Their results showed that postoperative recovery was better after laparoscopic surgery, and 5-year survival was identical. These results are consistent with other studies showing that laparoscopic colon resection provides better perioperative outcomes compared with open laparotomy, including decreased postoperative pain, earlier return to normal physical function, quicker return to bowel function, and shorter hospital stays. Society of Surgical Oncology 2009

Lessons Learned From the Analysis of 200 Laparoscopic Sigmoid Resections for Diverticulitis

Since the beginning of laparoscopic surgery indications for laparoscopic colon resections are still discussed controversively. In the latest studies benefit for laparoscopic approach is reported. The aim of this study was to evaluate the feasibility of laparoscopic sigmoid resections for diverticulitis regarding conversion rate, operation time and intraoperative and postoperative complications, and defining strategies to prevent complications. Out of a prospective database with all laparoscopic colon resection between May 1999 and January 2008 the patients with laparoscopic sigmoid resection for diverticulitis were analyzed. Preoperative diagnosis was made by abdominal computed tomography with irrigoscopy and/or endoscopy. Indications for laparoscopic sigmoid resections were diverticulitis as an early elective or elective operation and selected cases with perforated diverticulitis. Between May 1999 and January 2008, 200 patients (97 women, 103 men) were operated by laparoscopy for diverticulitis. Mean age at surgery was 59 years (range: 27 to 86); mean preoperative body mass index was 27.2 kg/m2 (range: 20 to 38). Mean operating time was 121 minutes (range: 60 to 239). Operating time was reduced due to experience and dropped from a mean of 150 minutes for the first 50 patients, 115 minutes for the second, 110 minutes for the third, and 107 minutes for the last 50 patients (P<0.05). Conversion rate was 1.5%, total morbidity rate was 19%, and reoperation rate was 6%. Laparoscopic sigmoid resections for diverticulitis can be performed with great safety and low conversion rate. Several adjustments in operation technique and perioperative management had to be done to achieve a complication rate and conversion rate at an acceptable low level.

Does age influence results of laparoscopic surgery for colorectal cancer in elderly patients?

Materials and methods Consecutive 87 patients who had laparoscopic resection of right colon, left colon, sigma and/or supraperitoneal rectum for colorectal carcinoma or adenoma with medium/severe dysplasia from June 2005 to August 2008 were included. Two age-matched cohorts of patients were compared: 45 patients (group 1) of 65 years or older and 42 patients younger than 65. All of the patients underwent preoperative exams, colonoscopy with multiple biopsy and CT-scan, and all data concerning demographics, disease, details of operations and postoperative events were collected prospectively.

Fast-Track Surgery of the Colon in Children

The aim of this study is to present the "fast-track" experience in children who underwent colon resection. Forty-six children who underwent laparoscopic colon resection were prospectively included in the study. Anomalies of colon innervation and inflammatory bowel disease represented the main surgical indications. Left colon/sigmoid resection was performed in 37, total colon resection was done in 5, and right colon resection in 4 children. Total colon resection was always associated to ileostomy. Anastomosis was performed in 41 cases. Patients were postoperatively monitored for pain, return to normal activity, feeding, bowel movements, and complications. Stool passage and oral feeding were started on postoperative day 1, and all patients were discharged before postoperative day 4. One child was readmitted the day after discharge because of an anastomotic leak. No other major complications were recorded. Minimally invasive surgery is safe and effective in pediatric colonic surgery and allows a fast recovery time (fast-track).

Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study

One-stage resection of primary colon cancer and synchronous liver metastases is considered an effective strategy of cure. A laparoscopic approach may represent a safe and advantageous choice for selected patients with the aim of improving the early outcome. Between January 2008 and October 2008, 7 patients underwent one-stage laparoscopic resection for primary colorectal cancer combined with laparoscopic or robot-assisted liver resection. A total of five laparoscopic left-colon, one right-colon, and one rectal resections were performed. Three patients underwent preoperative left-colon stenting and two received neoadjuvant chemotherapy. The patient with rectal cancer underwent neoadjuvant radiotherapy. Liver procedures included one bisegmentectomy (segments 2, 3), 3 segmentectomies, 6 metastasectomies, and four laparoscopic ultrasound-guided radiofrequency ablations (LUG-RFAs). One patient with multiple liver metastases was managed by a two-stage hepatectomy partially conducted by a totally laparoscopic approach. The overall postoperative morbidity was null. The median hospital stay was 10 days (range 7-10 days). This pilot study suggests that laparoscopic one-stage colon and liver resection is feasible and safe. Robot assistance may facilitate liver resection, increasing the number of patients who may benefit from a minimally invasive operation.

Prevalence of Internal Hernias After Laparoscopic Colonic Surgery

IntroductionLaparoscopic approach for colorectal resections is gaining popularity. Internal small bowel herniation (SBH) through a mesenteric defect has been described and, although rare, is a severe complication. The aim of this study was to evaluate the incidence and outcome of internal hernias after laparoscopic colorectal resection. Material and methodsDuring a 5-year period, all patients who underwent laparoscopic left colon resection were included in the study. A retrospective data base query was performed searching for all patients in whom SBH required surgical reintervention. ResultsA total of 436 laparoscopic left colorectal resections were performed from January 2000 to July 2006. Five male patients presented symptomatic internal hernias and required re-operation. Four had a resection for cancer and one for sigmoiditis. The mesenteric defect was not initially closed in three cases. In all cases, we found small bowel hernias through the mesocolon defect. One patient was re-operated on post-op day 2 for mesenteric ischemia and died after 24 h. DiscussionInternal hernia is a rare but fatal complication after laparoscopic colonic resection. Suspicion of this diagnosis requires emergency re-operation because symptoms are nonspecific. ConclusionAll mesenteric defects created during colorectal laparoscopy surgery should be meticulously closed.

Impact of incision length on the short-term outcomes of laparoscopic colorectal surgery

The recent introduction of hand-assist devices in laparoscopic colorectal surgery has renewed interest in the influence of incision length. This study aimed to define the impact of extraction incision length on the postoperative outcomes of laparoscopic left-sided colon and rectal resections. Consecutive patients undergoing laparoscopic left-sided colorectal resection from 1991 to 2007 were retrieved from a prospectively collected database. The association between incision length and patient characteristics, diagnosis, and perioperative outcomes were analyzed using logistic regression, Spearman correlation, Wilcoxon test, and chi-square test. A total of 494 laparoscopic colorectal resections (left, sigmoid, anterior, and low anterior resections) were retrieved. Patients with conversions to open surgery (n = 59) and missing data (n = 53) were excluded. As a result, 382 cases were included in the study. A slight majority of the patients had malignant disease (n = 202, 53%). The median incision length was 5 cm (interquartile range, 4-6 cm). Increasing weight was positively correlated with incision length (p = 0.0001). Male patients had modestly larger mean incisions than female patients (5.5 vs. 5.0 cm; p = 0.0075). Age, previous surgery, diagnosis, days to resumption of normal diet, and days to discharge from hospital showed no significant relationship with incision length. No association was observed between the incision length and intraoperative or postoperative complications. Patients undergoing laparoscopic colorectal surgery appear to achieve the same perioperative outcomes irrespective of their extraction incision lengths. To maintain the short-term benefits of laparoscopy, surgeons should consider pursuing a minimally invasive technique, even when a larger extraction incision will ultimately be required.

In-house colorectal laparoscopic preceptorship: a model for changing a unit’s practice safely and efficiently

There has been steady increase in demand for laparoscopic colonic resection as benefits are manifold compared to open and include smaller incisions, less pain, quicker recovery and convalescence, reduced morbidity and reduced analgesic demands. We devised a preceptorship programme with the aim of all four coloproctologists in our unit becoming proficient colorectal laparoscopic surgeons over a period of 12 months. The surgeon in the unit with significant experience of laparoscopic colorectal surgery acted as a preceptor to the remaining three. A prospective database was set up to allow analysis of the impact of the preceptorship on the units' elective practice and outcomes from January 2006. Results were analysed 106 cases to assess the success of this novel method and were more than encouraging. During this period, 57 laparoscopic resections were performed compared 49 open resections. The proportion of patients undergoing laparoscopic resection had risen from 20% to 80% (p = 0.000). This was associated with a significant drop in post-operative stay from 14 to 4 days (p = 0.000). Analysis of patient demographics, pathology and type of resection found there to be no significant difference between the open and laparoscopic groups. The conversion rate was acceptably low (10.5%) and there were no re-admissions. For hospitals with the facilities and an appropriately experienced preceptor, we offer this as a patient-safe, cost-neutral method of significantly increasing a units' laparoscopic practice over a relatively short period of time.

Laparoscopic Colon Resection by a Single General Surgeon in a Community Hospital: A Review of 200 Consecutive Cases

We assessed a single surgeon's experience on laparoscopic colorectal surgery (LCR) at a single non academic, community hospital. The surgeon was trained in minimally-invasive techniques and robotic surgery with >500 procedures at another non-university hospital, either as operating surgeon or as assistant. Short-term outcome of patients undergoing LCR for benign/neoplastic disease (June 2005-September 2007) was assessed. A total of 208 patients (104 males, 104 females; median age 69.1 years, Interquartile Range (IQR):59.3-76.6) underwent LCR. Over 70% of the operations were performed for cancer. Left hemicolectomy was performed in 102 patients (49.1%), right hemicolectomy in 50 (24%), anterior resection in 40 (19.2%), other procedures in 16 (7.7%). One-hundred-ninety (91.3%) operations were elective. The median operative time was 180 min (IQR:150-210). Conversion rate was 4.8%: 3.4% for benign and 5.4% for neoplastic disease (p = n.s.). The median lymph node harvest in cancer patients was 16 (IQR:12-20). Mortality and overall morbidity rates were 0.5% and 13%, with no significant difference between benign and malignant disease, colon and rectum, elective and non elective operations. The outcomes of LCR surgery performed by a well-trained laparoscopic surgeon working in a community hospital are comparable with results from academic health science centers.

Laparoscopic Colectomy

Laparoscopic colectomy can be performed using 2 approaches: lateral or medial. However, it is unknown if one of these techniques provides better results. Thus, the object of the present study is to assess whether one of the approaches has any potential benefits over the other. A comparative, retrospective study was performed that included all patients scheduled for left and right laparoscopic colon resection for both neoplastic and benign diseases between June 2000 and June 2006. The following factors were assessed: operation time, recovery variables (bowel sounds, passage of gases, intake of liquids and solids), length of hospital stay, and morbidity and mortality rates. The population was divided into 4 groups: right colectomy using a lateral approach (RL); right colectomy using a medial approach (RM); left colectomy using a lateral approach (LL); and left colectomy using a medial approach (LM). A total of 202 patients were evaluated: RL: 16 (8%); RM: 37 (18.3%); LL: 110 (54.4%); LM: 39(19.3%). No differences in recovery parameters were observed between the right colectomies. However, the presence of bowel sounds and solid intake was significantly earlier in the patients subjected to left colectomies using a medial approach. A tendency toward a higher conversion rate was observed in left colectomies with lateral approach (LL: 18 vs. LM: 1, P=0.052). The operation time was significantly shorter when a medial approach was used for both right and left colectomies (RL: 185.6 min vs. RM: 148.6 min, P=0.009; LL: 205.5 min vs. LM: 139.9 min, P<0.0001). No differences in the morbidity and mortality rates were found between lateral and medial approach in both types of colectomy. The use of a medial approach in a laparoscopic colectomy provides short-term benefits compared with a lateral approach.