Laparoscopic Hemicolectomy Research Articles

Transverse skin crease versus vertical midline incision versus laparoscopy for right hemicolectomy: a systematic review--current status of right hemicolectomy.

Purpose. The right hemicolectomy may be conducted through laparoscopic or laparotomic surgery, transverse or midline incisions. The transverse laparotomy offers some advantages compared to the midline laparotomy and laparoscopy. A literature review was performed to evaluate the possible advantages of the transverse incision versus midline incision or laparoscopic right hemicolectomy. Methods. A systematic research was performed in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, and the Science Citation Index. Results. Laparotomic right hemicolectomy with transverse incision is preferable to laparotomic hemicolectomy with midline incision. A transverse incision offers a lessened postoperative pain following physical activity, a lessened need to administer analgesic therapy during the post-operative time, better aesthetic results, and a better post-operative pulmonary function. Open surgery with transverse or midline incision ensured a shorter operative time, lower costs and a greater length of the incision compared to the laparoscopic. However, there are no differences in the oncological outcomes. Conclusions. It was not possible to identify significant differences between the open right hemicolectomy with transverse incision versus the open right hemicolectomy with midline incision or laparoscopic hemicolectomy.

General anesthesia for a patient with multiple system atrophy.

General anesthesia for a patient with multiple system atrophy.

Robotic-Assisted Intracorporeal Anastomosis Versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy for Cancer: A Case Control Study

Extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for cancer has a significant risk of complications. The aim of this study is to evaluate the operative and postoperative results of hybrid right hemicolectomy with intracorporeal robotic-assisted anastomosis for adenocarcinoma of the ascending colon compared with the standard extracorporeal anastomosis in a case control study. Forty-eight right hemicolectomies for cancer (2009-2012) with laparoscopic medial to lateral dissection, vascular ligation, bowel transection, and robotic-assisted intracorporeal anastomosis with specimen extraction through a Pfannestiel incision (robotic group [RG]) were compared with 48 laparoscopic hemicolectomies (2009-2011) with extracorporeal anastomosis (laparoscopic group [LG]). The two groups were comparable with respect to age, gender, stage of cancer, and body mass index. Surgery time was significantly longer in RG patients (RG, 266±41 minutes; LG, 223±51 minutes; P<.05). Operative results were similar in the two groups. Recovery of bowel function (day of first bowel movement: RG, 3.0±1.0 days; LG, 4.0±1.2 days; P<.05) and hospital stay (RG, 7.5±2.0 days; LG, 9.0±3.2 days; P<.05) were quicker and shorter, respectively, in RG. There were four anastomotic complications and four incisional hernias in LG and none in RG (P<.05). There are fewer anastomotic and wound complications in RG patients. Intracorporeal robotic-assisted ileocolic anastomosis allows a faster recovery compared with extracorporeal anastomosis.

Laparoscopic Hemicolectomy in Ascending Colon Cancer with Situs Inversus Totalis

Introduction: Situs inversus totalis (SIT), occurring at a frequency of 1:5000–1:10,000 live births,1 is characterized by a complete right-to-left transposition of the thoracic and abdominal organs. Only five cases of laparoscopic colon surgery in an SIT patient have been reported. The present case describes a laparoscopic hemicolectomy necessitated by ascending colon cancer in a patient with SIT. Patient and Methods: A 54-year-old woman with ascending colon cancer was referred to our hospital. Preoperative chest radiography showed dextrocardia, and computed tomography showed complete transposition of the abdominal viscera, confirming a diagnosis of SIT. The patient, free of distant metastasis, underwent laparoscopic right hemicolectomy and radical lymphadenectomy, performed by a surgeon experienced in laparoscopic colectomies. After inducing general anesthesia, the patient was placed in a modified lithotomy position, with the operator and scopist situated on the patient's right and the first assistant on the patient's left, similar to the positioning used in laparoscopic anterior resections. A 10-mm umbilicus trocar was inserted for the camera, and 5-mm trocars were placed in the right and left iliac fossa and subcostal areas, as working ports. Trocars were inserted symmetrically, we usually use this trocar system in Rt. hemicolectomy. The ascending colon, located on left side of patient, was mobilized along with the tumor, and the ileocolic vessels and right colic artery were identified and ligated. Radical lymphadenectomy was performed after ligation of the root of the middle colic artery and the right branch of middle colic artery. The umbilical wound was extended by ∼5 cm to allow for extracorporeal anastomosis and removal of the tumor; colon reconstruction was performed using a double-stapling technique. Results and Conclusions: The operation time was 120 minutes, with minimal blood loss. The resected tumor was a 1.5×1.2-cm Bormann type II moderately differentiated adenocarcinoma. The depth of the tumor's invasion into the submucosa was classified as pT1; no lymph node metastasis or angiolymphatic invasion was observed. The patient, discharged 7 days after surgery, did not receive postoperative adjuvant chemotherapy, and was free of complications and evidence of recurrence at her 2-year follow-up examination. Previous reports on cases of laparoscopic surgery in SIT patients1–3,11–14 have described the technical difficulties associated with the abnormal anatomy. In the present case, the surgical team needed to understand the modified vessel anatomy and orientation to avoid confusing the right colic artery with the ileocolic artery. Meticulous preoperative planning, including the selection of proper locations for the trocars, positioning of surgical personnel, and selection of a well-experienced surgeon, was essential for the successful outcome. The authors did not receive any grant or financial support to perform this study. Runtime of video: 7 mins 13 secs

Laparoscopic hemicolectomy in a patient with situs inversus totalis after open distal gastrectomy

Situs inversus totalis (SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. Occasionally, a few patients with a combination of this condition and malignant tumors have been encountered. Recently, several laparoscopic operations have been reported in patients with SIT. We report a case of an 83-year-old man with situs inversus totalis who developed colon cancer after open distal gastrectomy. Laparoscopic hemicolectomy with radical lymphadenectomy in such a patient was successfully performed by careful consideration of the mirror-image anatomy. Techniques themselves was not different from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus totalis is feasible and safe.

Evaluation of the Single-Port Laparoscopic Right Hemicolectomy Learning Curve

Background: The use of single-port laparoscopy has gained popularity within recent years. Part of the appeal in learning this approach is that it draws heavily from concepts mastered through conventional laparoscopy. Various studies have shown the efficacy and feasibility of the single-port laparoscopic approach, but there are few that examine the learning curve in adopting this new technique. Objective: Our goal was to better define the learning curve in performing a single-port laparoscopic right hemicolectomy. Design: A review of prospectively gathered operative data was performed to analyze the results of single-port laparoscopic right hemicolectomies performed within our institution by experienced laparoscopic surgeons. The first 100 cases were divided into quintiles. Comparisons were made among the cohorts regarding patient demographics, operative time, length of stay, conversions, and complications. Results: There was no difference among quintiles with regard to age, sex, BMI, or ASA class. Operative time, conversions, length of stay, and number of complications did not significantly vary among each group of patients. There was a significant difference in estimated blood loss and length of stay between the fifth cohort and the others due to one patient’s poor outcome. Conclusions: The single-port laparoscopic right hemicolectomy learning curve for surgeons already skilled in laparoscopy is short. There are few differences in various outcome measures among groups at any stage in the learning curve. The skills utilized to perform conventional laparoscopic colorectal surgery readily translate to the single-port approach and result in proficiency from nearly the start.

Single-Port Laparoscopic Right Hemicolectomy: Intermediate Results

Single-port laparoscopic colectomy was first described in 2008 as a new technique for colorectal surgery. No available reports have stated the intermediate- or long-term outcome. We report our intermediate results for the first 20 single-port laparoscopic right hemicolectomies performed by a single laparoscopically trained surgeon at our institution. Between February 2009 and September 2010, 20 consecutive patients with an indication for right hemicolectomy who were candidates for laparoscopic surgery underwent a single-port laparoscopic approach. The only exclusion was a previous midline laparotomy. The patients were followed for outcomes after a median of 27 months (range: 15 to 35). The mean age was 65 years (range: 59 to 88). The mean body mass index was 28 (range: 20 to 35). Seventy five percent of patients had significant comorbidities, with an American Society of Anesthesiologists class of III or IV. The median estimated blood loss was 25 mL (range: 25 to 250). The mean number of lymph nodes was 13 (range: 0 to 29). There was one conversion to hand-assisted laparoscopic colectomy and one to open colectomy secondary to bleeding. The mean hospital stay was 5 days (range: 3 to 7). Thirty-day postoperative complications included 1 wound infection, 1 patient with alcohol withdrawal, and 1 incidence of colitis caused by Clostridium difficile infection. At a median follow-up of 27 months, there were no local recurrences or distant metastases. One death occurred at 17 months from myocardial infarction. Two patients developed incisional hernias, with one requiring a laparoscopic hernia repair. One patient required a completion proctocolectomy for a pathological diagnosis of hyperplastic polyposis syndrome. Single-port laparoscopic right hemicolectomy has been safely performed in patients who are candidates for conventional laparoscopic hemicolectomy. This small series indicates that intermediate-term results are similar to conventional laparoscopic surgery in efficacy, safety, and oncological outcomes. Larger datasets are necessary to determine cost-effectiveness, differences in postoperative outcomes, and patient satisfaction.

Laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach

Lapareseopic colectomy is commonly performed,but laparoscopic extended right hemicolectomy with D3 lymphadenectomy for cancer located at hepatic flexure of the colon is a complex procedure,even in the hands of experts.Laparoscopic dissection of the lymph nodes around the middle colonic and right gastroepiploic vessels are so complicated that precise vascular anatomy and surgical plane are essential to complete this procedure safely.We herein describe a standard technique for performing laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach.The main surgical plane of this procedure is the right Toldt's space.The superior mesenteric vein (SMV) is the most important anatomical landmark of vascular dissection.Medial-to-lateral approach makes it easy to locate the right Toldt's space and the SMV. Key words: Colonic neoplasms ; Laparoscopy ; Extended right hemicolectomy ; Anatomical landmark ; Complete mesocolic excision ;

Vascular anatomy of the right colon and vascular complications during laparoscopic surgery

To analyze the vascular anatomy and complications of the right colon under laparoscope. Videotapes of 55 laparoscopic extended right hemicolectomy with D3 lymphadenectomy were reviewed and the anatomic relationship and bleeding vessels were determined. The superior mesenteric vein, superior mesenteric artery, ileocolic artery, and middle colic artery were present in all the patients. The right colic artery was present in 45.5%(25/55) of the patients. The incidence of the gastrocolic venous trunk was 74.5%. The overall incidence of intraoperative bleeding was 43.6%. Vessels in the pre-pancreatic region including the right gastroepiploic artery, the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding than the middle colic vein and artery (16.4% vs. 14.5%). Intraoperative bleeding significantly prolonged the overall operative time and lymphadenectomy time. The vascular anatomy of the right colon is intricate and variable and laparoscopic extended right hemicolectomy with D3 lymphadenectomy is associated with a high risk of hemorrhage. Understanding the vessels anatomic relationship of the right colon is valuable to decrease vascular complication.

Opioid‐Free Perioperative Analgesia for Hemicolectomy in a Patient With Opioid‐Induced Delirium: A Case Report and Review of the Analgesic Efficacy of the Alpha‐2 Agonist Agents

Surgical pain in patients with documented opioid-induced delirium can be difficult to treat. We present a case of a patient undergoing laparoscopic hemicolectomy effectively treated with an opioid-free, alpha-2 adrenoreceptor agonist analgesic regimen. A 21-year-old woman with persistent abdominal pain presented to the operating room for laparoscopic hemicolectomy for redundant right colon. Her medical history included a recently diagnosed postoperative opioid-induced delirium. Epidural infusion with local anesthetic offered partial pain relief with sensory levels of T9-L2. With the addition of dexmedetomidine infusion in the immediate postoperative period, the patient was comfortable with pain scores of 1 to 2/10 on Numerical Rating Scale (NRS). On postoperative day 1, the infusion was discontinued and the clonidine, 12 μg/hours was added to the epidural bupivacaine. With increased sedation 48 hours later, neuraxial clonidine was discontinued in favor to transdermal clonidine 0.1 mg/week, which was maintained until hospital discharge. Pain scores were maintained at 2 to 3/10 on NRS for the next 3 days when increased abdominal distention because of abscess formation rendered a new surgical intervention. The analgesia for the exploratory laparoscopy was maintained using epidural clonidine and bupivacaine infusion as well as intravenous dexmedetomidine, which were maintained another 2 days. Pain scores remained minimal until discharged home 3 day later. Nonopioid analgesic regimens are beneficial in patients at risk of postoperative cognitive dysfunction attributable to opioids. Successful postoperative analgesia was achieved in our patient by alternating various routes of administration of alpha-2 adrenoreceptor agonists.

腸結核治療中に回盲部狭窄をきたし腹腔鏡下に切除した1例

40歳，女性．検診で便潜血陽性および貧血を指摘され，大腸内視鏡検査を施行．上行結腸に潰瘍を認めた．組織の結核菌培養検査で結核菌が認められたため，腸結核と診断．抗結核薬による治療を開始した．内服治療中，右側腹部痛を主訴に外来を受診．腹部CT検査にて拡張，壁肥厚を伴う上行結腸を認めた．病変部の瘢痕収縮による狭窄が原因と考えた．CT所見，理学所見から剥離受動可能と考え腹腔鏡下右半結腸切除術施行した．病理結果では潰瘍瘢痕による線維性肉芽組織の増生が認められるものの肉芽腫性病変は認められなかった．総合判断では腸結核性潰瘍の瘢痕収縮であると考えた．退院後は当科外来に通院中であるが抗結核薬は投与せず経過観察中である．腸結核に対し抗結核薬治療を行った場合，腸管狭窄を生じ，その結果イレウスとなることがある．そうした腸結核の腫瘤および狭窄に対して腹腔鏡下手術は可能であることが示唆された．

Overnight Hospital Stay After Colon Surgery for Adenocarcinoma

A short hospital stay is one of the main advantages of the laparoscopic surgical technique. The process of developing and studying the "fast-track" process has contributed to a better understanding of the elements of perioperative care and has resulted in the reduction in length of stay (LOS) after colectomies. As we follow and refine this well-recognized multimodal approach, further decreases in the LOS can be expected. We present 2 octogenarian patients who, after receiving laparoscopic hemicolectomies for malignant disease, were discharged home < 24 hours after their operations. Postoperative follow-ups did not show any adverse reaction to the early discharge. Modifying the multimodal perioperative technique with further refinement to the surgical technique appears to allow patients to be discharged home in the first 24 hours following laparoscopic colectomy.

Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy

This case-control study compared the clinical outcomes of totally laparoscopic hemicolectomy with natural orifice specimen extraction (NOSE) and the conventional laparoscopically assisted approach for right-sided colonic cancer. Consecutive patients who underwent totally laparoscopic mobilization of the right colon with transvaginal resection, anastomosis and specimen extraction between April 2007 and December 2009 were matched by various clinicopathological characteristics with patients who had conventional laparoscopically assisted procedures. Thirty-four patients in each group were studied. The number of lymph nodes harvested and the resection margin status were similar in the two groups. After NOSE, patients experienced less pain (mean(s.e.m.) pain score on day 1: 4·2(0·3) versus 5·7(0·3), P = 0·001; on day 3: 2·6(0·2) versus 3·5(0·2), P = 0·010) and had a shorter hospital stay (mean(s.d.) 7·9(0·8) versus 8·8(1·5) days; P = 0·003). The NOSE group had less surgical morbidity than the laparoscopically assisted group, but the difference was not significant (4 of 34 versus 9 of 34; P = 0·119). After a median follow-up of 23 (range 5-40) months, there was no transvaginal access-site recurrence or posterior colpotomy-related complications. NOSE was associated with significantly better cosmetic results (mean(s.d.) score 7·5(1·7) versus 6·6(1·8); P = 0·037). The NOSE approach is feasible with favourable short-term surgical outcomes.

A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy

IntroductionThere is still insufficient scientific evidence on which is the best technique to perform the anastomosis -intracorporeal (IC) or extracorporeal (EC)- in right laparoscopic hemicolectomy. The objective of the present study is to determine whether there are differences to compare in both techniques. Material and methodsA study was performed on a prospective patient series subjected to right laparoscopic hemicolectomy in our Hospital. The preoperative and the postoperative variables associated with complications recorded depending on the type of anastomosis. ResultsA total of 60 patients were intervened form June 2004 to June 2010 (35 IC; 25 EC). There were no significant differences between both groups as regards baseline preoperative characteristics or associated comorbidities. The median operation time was 212 minutes (142–305min), with no significant difference between both techniques. The number of lymph nodes removed was higher in the IC group (21 vs 14; P=.03). The beginning of oral tolerance and the first bowel movement were significantly earlier in the IC group. The complications rate was similar for both groups (14% IC; 16% EC; P=.89). Three patients in the IC group had anastomosis dehiscence. The mortality rate was 2.8% (one patient in each group) ConclusionIntracorporeal versus extracorporeal anastomosis in right laparoscopic hemicolectomy can obtain a higher number of resected lymph nodes and an earlier oral tolerance and intestinal transit.

Estudio de casos y controles entre anastomosis intra y extracorpórea en pacientes intervenidos de hemicolectomía derecha laparoscópica

Introduction There is still insufficient scientific evidence on which is the best technique to perform the anastomosis -intracorporeal (IC) or extracorporeal (EC)- in right laparoscopic hemicolectomy. The objective of the present study is to determine whether there are differences to compare in both techniques. Material and methods A study was performed on a prospective patient series subjected to right laparoscopic hemicolectomy in our Hospital. The preoperative and the postoperative variables associated with complications recorded depending on the type of anastomosis. Results A total of 60 patients were intervened form June 2004 to June 2010 (35 IC; 25 EC). There were no significant differences between both groups as regards baseline preoperative characteristics or associated comorbidities. The median operation time was 212 minutes (142-305 min), with no significant difference between both techniques. The number of lymph nodes removed was higher in the IC group (21 versus 14; p = 0.03). The beginning of oral tolerance and the first bowel movement were significantly earlier in the IC group. The complications rate was similar for both groups (14% IC; 16% EC; p = 0.89). Three patients in the IC group had anastomosis dehiscence. The mortality rate was 2.8% (one patient in each group). Conclusion Intracorporeal versus extracorporeal anastomosis in right laparoscopic hemicolectomy can obtain a higher number of resected lymph nodes and an earlier oral tolerance and intestinal transit.

Hemicolectomía derecha laparoscópica por puerto único para cáncer de colon

Single-port access right laparoscopic hemicolectomy for colon cancer A new laparoscopic technique allows a peritoneal access through a single umbilical port with less abdominal wall trauma and pain. We report a 64 years old male with a right colon adenocarcinoma, detected during a routine colonoscopy. The patient was subjected to a right laparoscopic hemicolectomy through a single SILS ® Multiple Instrument Access Port, that can accommodate up to three instruments introduced through a 3 cm paraumbilical incision. The surgical procedure was uneventful and the patient had a good postoperative evolution. The pathological study of the surgical piece confirmed the presence of an adenocarcinoma with invasion of the submucosa and without lymph node involvement.

Squamous cell carcinoma of the anus in a patient with perianal Crohn’s disease

Dear Editor Anal cancer is a rare disease and accounts for approximately 1.86% of all carcinomas originating in the digestive system. The American Cancer Society estimates that in 2008, there will be 5,070 new cases of anal cancer and 680 deaths from anal cancer in the USA. Anal cancer arising in patients with Crohn’s disease is also rare. The incidence or prevalence of anal carcinoma in Crohn’s disease is not sufficiently reported. According to Slater et al., the percentage of anal cancer in colorectal cancer in patients with Crohn’s disease is higher than that in patients with non-inflammatory bowel disease (IBD; 14% versus 1.4%, respectively, p<0.005). On the other hand, Frisch et al. reported one case of anal squamous cell carcinoma (SCC) among 2,723 Crohn’s patients with a median follow-up of 10.2 years and concluded that the rate of anal SCC is not significantly increased, even in IBD patients, as compared with the general population. Incidence rates of IBD diverge geographically. Traditionally, Northern Europe, the UK, and North America have a high prevalence of IBD. The incidence and prevalence rates of IBD in Asia are low compared with the West. According to a recently published epidemiologic study by Thia et al., incidence rates of Crohn’s disease in Japan, South Korea, and Hong Kong are similar, ranging from 1.00 to 1.34 cases per 10 person-years over a combined time period from 1998 to 2005, and interestingly, the incidence of Crohn’s disease is increasing in these areas. Approximately 40 cases of carcinoma that developed from anal lesions or in association with anal or rectal fistulas arising in patients with Crohn’s disease were reported in English literature from 1980 to 2008. Most of these cases were reported from Northern Europe or North America, and as far as we know, reports from East Asia are very rare. Our hospital is a tertiary referral center in South Korea. From 1991 to 2008, 843 patients were treated for IBD. We report the first case of SCC arising in a patient with perianal Crohn’s disease in our hospital. A 43-year-old woman had an 11-year history of Crohn’s disease. She underwent large loop excision of the transformation zone due to cervical cancer (carcinoma in situ) in 1997. Despite regular follow-up with sulfasalazin, steroid, or intermittent infliximab treatment, the patient developed enteroenteric fistulas as well as an anal stricture and multiple perianal fistulas. Even though the patient received conservative medical treatment, a small-bowel fistula did not resolve, and the patient suffered an increasing frequency of low abdominal pain with an engrowing palpable mass in the right lower abdomen. She underwent laparoscopic assisted right hemicolectomy, segmental resection of the small bowel, end ileostomy, and seton drainage for the rectovaginal fistula in January 2008. Fecal diversion was performed to relieve the perianal discomfort induced by J. Kang : B. S. Min :K. Y. Lee :N. K. Kim (*) Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, South Korea 120-752 e-mail: namkyuk@yuhs.ac

Patient-Controlled Analgesia versus Oral Controlled-Release Oxycodone – Are They Interchangeable for Acute Postoperative Pain after Laparoscopic Colorectal Surgeries?

Background: Standard therapy for postoperative pain after laparoscopic colorectal surgeries at the Tan Tock Seng Hospital consists of intravenous morphine via patient-controlled analgesia (PCA) for the first 24–48 h, followed by oral analgesics. We compared the efficacy and safety of oral controlled-release (CR) oxycodone hydrochloride (OxyContin® tablets) and PCA after laparoscopic colorectal surgeries. Methods: Between March and August 2006 (phase 1 study), 14 patients underwent laparoscopic colectomy, laparoscopic hemicolectomy or laparoscopic-assisted anterior resections. All patients were on oral CR oxycodone with oral immediate-release oxycodone on an as-needed basis for breakthrough pain. Pain intensity, analgesic use, length of hospital stay and side effects were evaluated. These were compared to data obtained from a second study of a similar design where 9 patients underwent similar operations from October 2006 to July 2007 (phase 2 study) and were on PCA morphine. Results: All patients in the CR oxycodone and PCA morphine groups needed the opioid medication for only 2 days. There was no difference in mean (range) postoperative pain intensity scores between patients on oxycodone and those on PCA morphine for the 1st postoperative day [2.07 (0–5) vs. 2.78 (2–4) on a Visual Analogue Scale (VAS) from 0 to 10; p = 0.10] and the 2nd postoperative day [1.14 (0–2) vs. 1.67 (0–3); p = 0.10]. Generalized estimating equations with linear link function confirmed that there was a significant relief of pain in patients after operation. On average, the VAS score of pain was 1.00 units lower on day 2 when compared with day 1 (p < 0.01). The mean (range) doses of oxycodone used on the 1st and 2nd postoperative day were 13.57 mg (10–30) and 15.36 mg (10–30), and the mean (range) doses of morphine used on the 1st and 2nd postoperative day were 14.9 mg (8–28) and 16.3 mg (4–31), respectively. Incidence of nausea and vomiting was 14.2 and 20% for the CR oxycodone and PCA groups, respectively. Conclusions: Oral CR oxycodone 20 mg per day is a cheaper, convenient and an efficacious alternative analgesic to PCA opioids after laparoscopic colorectal surgery.

Laparoscopic Right Hemicolectomy for Goblet-Cell Carcinoid of the Appendix: Report of a Rare Case and Literature Survey

Tumors of the appendix are rare entities, and the majority of them are discovered accidentally during an investigation for other conditions. Laparoscopic surgery for appendiceal goblet-cell carcinoid (GCC) has only been reported once before. Our patient was incidentally discovered to have an appendiceal tumor and was referred to us for laparoscopy. The tumor involved the body of the appendix and was adherent to the cecum. A laparoscopic hemicolectomy was successfully performed for the patient. Postoperative recovery was uneventful. Histopathology confirmed an appendiceal goblet-cell carcinoid. Immunohistochemistry was negative for the neuroendocrine markers, CK20 and CK7. GCC is a rare tumor of the appendix. Hemicolectomy is indicated in specific situations, such as local involvement or tumor size >2 cm. In our patient, the tumor was adherent to the cecum and tumor size was 5 cm. Therefore, a laparoscopic right hemicolectomy was performed primarily. There are several reports in the literature supporting both the laparoscopic and open approaches. Laparoscopic surgery for appendiceal tumors is safe, feasible, and even may be beneficial.

Laparoscopic hemicolectomy in a patient with situs inversus totalis

As among persons with normal anatomy, occasional patients with situs inversus develop malignant tumors. Recently, several laparoscopic operations have been reported in patients with situs inversus. We describe laparoscopic hemicolectomy with radical lymphadenectomy in such a patient. Careful consideration of the mirror-image anatomy permitted safe operation using techniques not otherwise differing from those in ordinary cases. Thus, curative laparoscopic surgery for colon cancer in the presence of situs inversus is feasible and safe.