Laparoscopic Resection For Colon Cancer Research Articles

Deep learning-based surgical step recognition for laparoscopic right-sided colectomy.

Understanding the complex anatomy and surgical steps involved in laparoscopic right-sided colectomy (LAP-RC) is essential for standardizing the surgical procedure. Deep-learning (DL)-based computer vision can achieve this. This study aimed to develop a step recognition model for LAP-RC using a dataset of surgical videos with annotated step information and evaluate its recognition performance. This single-center retrospective study utilized a video dataset of laparoscopic ileocecal resection (LAP-ICR) and laparoscopic right-sided hemicolectomy (LAP-RHC) for right-sided colon cancer performed between January 2018 and March 2022. The videos were split into still images, which were divided into training, validation, and test sets using 66%, 17%, and 17% of the data, respectively. Videos were manually classified into eight main steps: 1) medial mobilization, 2) central vascular ligation, 3) dissection of the superior mesenteric vein, 4) retroperitoneal mobilization, 5) lateral mobilization, 6) cranial mobilization, 7) mesocolon resection, and 8) intracorporeal anastomosis. In a simpler version, consecutive surgical steps were combined, resulting in five steps. Precision, recall, F1 scores, and overall accuracy were assessed to evaluate the model's performance in the surgical step classification task. Seventy-eight patients were included; LAP-ICR and LAP-RHC were performed in 35 (44%) and 44 (56%) patients, respectively. The overall accuracy was 72.1% and 82.9% for the eight-step and combined five-step classification tasks, respectively. The automatic surgical step-recognition model for LAP-RCs, developed using a DL algorithm, exhibited a fairly high classification performance. A model that understands the complex steps of LAP-RC will aid the standardization of the surgical procedure.

SP3.10 - Utilisation and Outcomes of Emergency Laparoscopic Resection for Colon Cancer: A Population-based Study in England

Abstract Aims To evaluate the current use and outcomes of urgent or emergency laparoscopic resection of colon cancer in the National Health Service in England. Methods 11,182 patients from the National Bowel Cancer Audit diagnosed with colon cancer from April 2017 to March 2022 in England, who underwent urgent or emergency resection, were included. Multivariable logistic and linear regression was used to quantify factors associated with use of laparoscopic surgery and compare risk-adjusted postoperative outcomes between laparoscopic and open surgery. Results The use of emergency laparoscopic resection increased from 33.0% in 2017 to 47.5% in 2022, with a temporary stabilisation during the first wave of the COVID-19 pandemic (38.9% 2020/21). In risk-adjusted analyses of 9,579 patients, patients with poorer physical status [ASA 4/5 vs 1, aOR 0.35 (95% confidence interval 0.27-0.44) P < 0.001], more advanced T-stage [T4 vs T1-T2, aOR 0.26 (0.21-0.32) P < 0.001] and M-stage [M1 vs M0, aOR 0.87 (0.76-0.99) P < 0.036] were less likely to undergo laparoscopic surgery. No association was found with age, socioeconomic deprivation, or nodal stage. Patients undergoing laparoscopic resection had a shorter length of stay [adjusted mean difference -2.55 days (-3.23, -1.87), P < 0.001], lower 90-day mortality [aOR 0.75 (0.63-0.89), P = 0.001], and lower 30-day unplanned reoperation [aOR 0.82 (0.70-0.96), P = 0.014] than patients undergoing open resection. Conclusion There has been an increased utilisation of laparoscopic surgery in the emergency setting, and it is associated with reduced hospital stay, postoperative mortality and unplanned reoperation.

Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis.

Although intracorporeal anastomosis (IA) for colon cancer requires longer operative time than extracorporeal anastomosis (EA), its short-term postoperative results, such as early recovery of bowel movement, have been reported to be equal or better. As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum, there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells. However, intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified. To clarify the effects of bacterial and tumor cell contamination of the intra-abdominal cavity in IA. Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020, 75 underwent EA (EA group), and 52 underwent IA (IA group). After propensity score matching, the primary endpoint was 3-year disease-free survival rates, and secondary endpoints were 3-year overall survival rates, type of recurrence, surgical site infection (SSI) incidence, number of days on antibiotics, and postoperative biological responses. Three-year disease-free survival rates did not significantly differ between the IA and EA groups (87.2% and 82.7%, respectively, P = 0.4473). The 3-year overall survival rates also did not significantly differ between the IA and EA groups (94.7% and 94.7%, respectively; P = 0.9891). There was no difference in the type of recurrence between the two groups. In addition, there were no significant differences in SSI incidence or the number of days on antibiotics; however, postoperative biological responses, such as the white blood cell count (10200 vs 8650/mm3, P = 0.0068), C-reactive protein (6.8 vs 4.5 mg/dL, P = 0.0011), and body temperature (37.7 vs 37.5 °C, P = 0.0079), were significantly higher in the IA group. IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.

Colonoscopy combined with laparoscopy can improve post‐operative quality of life in patients with colon cancer

AbstractAimThe study aimed to elucidate the clinical efficacy of colonoscopy combined with laparoscopic radical resection for patients with colon cancer.MethodsCases with colon cancer were divided into the control group (received laparoscopic radical resection) and the experimental group (received colonoscopy combined with laparoscopic radical resection). Inflammatory cytokines’ levels and immune functions were evaluated before and after the operation. The 36‐item Short Form Health Survey (SF‐36) was used to evaluate the living quality.ResultsRelative to the control group, individuals in the experimental group had a shorter hospital stay and post‐operative anal exhaust, and reduced intraoperative blood loss. Changes in serum interferon‐gamma (IFN‐γ), interleukin‐8 (IL‐8) and IL‐10 levels were minimal in the experimental group. Serum CD3+%, CD4+% and CD4+/CD8+ values of the two groups were significantly decreased compared with the preoperative values, which increased more significantly in the experimental group relative to the control group. After the operation, individuals in the experimental group presented higher SF‐36 scores than those in the experimental group. The experimental group presented a low incidence of post‐operative complications.ConclusionsColonoscopy combined with laparoscopic radical resection for colon cancer had only a little effect on immune function and inflammatory response. It can shorten the recovery time of patients and reduce post‐operative complications, which is worthy of further clinical promotion.

Effect of refined management in operating room nursing on surgical efficiency and nursing satisfaction during laparoscopic radical resection of colon cancer

Effect of refined management in operating room nursing on surgical efficiency and nursing satisfaction during laparoscopic radical resection of colon cancer

Clinical application of two-port laparoscopic surgery in sigmoid colon and upper rectal cancer resection.

In the field of minimally invasive surgery, the two-port laparoscopic surgery is on the rise. This study investigated the safety and efficacy of two-port laparoscopic surgery (TLS) for resecting sigmoid colon and upper rectal cancers compared with conventional laparoscopic surgery (CLS). The clinical data of patients undergoing laparoscopic sigmoid colon cancer and upper rectal cancer resection at the Department of General Surgery of the First Affiliated Hospital of Gannan Medical College between July 2019 and January 2022 were retrospectively collected. Grouped according to different laparoscopic surgery. Based on the inclusion and exclusion criteria,A total of 81 patients were enrolled, of the 25 patients from the TLS group,and of the 56 patients from the CLS group. We mainly compared whether there were statistical differences between the two groups in terms of operative time, intraoperative bleeding, incision length, time to first ambulation, time to first flatus, time to first defecation, postoperative complication rate, and other surgical outcomes. There was no statistical difference between the two groups in terms of baseline clinical characteristics (P > 0.05). In terms of the surgical outcomes, there were statistical differences in the total incision length (TLS: 6.21 ± 0.67cm, CLS: 8.64 ± 1.08cm, P < 0.001)), time to first ambulation (TLS: 2.0 ± 0.7d, CLS:3.1 ± 0.9d, P < 0.001), time to first flatus (TLS: 2.5 ± 0.8d, CLS: 3.0 ± 0.8d, P = 0.028), time to first defecation (TLS: 3.8 ± 1.3d, CLS: 5.1 ± 2.1d, P = 0.010), and time for liquid diet (TLS: 4.3 ± 1.4d, CLS: 5.3 ± 1.9d, P = 0.021). There was no statistical difference between the two groups in terms of the pathology (P > 0.05). In terms of safety, TLS in sigmoid colon and upper rectal cancer resection is comparable to CLS. However, its incision is smaller and more aesthetic, and it causes lesser trauma than CLS. Additionally, it is also superior to CLS in postoperative recovery.

The value of ICG-guided left colon vascular variation and anatomical rules for the radical resection of proctosigmoid colon cancer.

During laparoscopic radical resection for proctosigmoid colon cancer (PCC), surgeons could inadvertently damage the arteries when following the operation path.This study investigated the variations in left colon blood vessels in order to guide the scientific protection of the marginal artery (MA) during laparoscopic surgery for PCC. Data from seven patients who underwent inferior mesenteric artery (IMA) angiography were included as imaging references to preliminarily explore the vascular structure and variation in the left colon. The clinical video data of 183 PCC patients were retrospectively analyzed to observe intraoperative MA injury. Meanwhile, a prospective cohort of 96 patients with the same disease underwent intraoperative indocyanine green (ICG) fluorescence imaging of the peripheral sigmoid artery network, the variation of marginal arteries was summarized, and the distance between vessels and the bowel was measured at different levels. Patients were divided into 'ICG group' and 'non-ICG group' according to whether ICG guidance was performed, and perioperative conditions were compared between the two groups. Taking the integrity of lymph node dissection into consideration, 18 patients underwent carbon nanonode tracing. This study was conducted under the standard consent and ethical approval of the Ethics Committee of our center. 7 patients with IMA angiography shared some vascular structures, defined as 'Dangerous Triangle' and 'Secure Window'. Through intraoperative observation, the primary arch was typically located 4.2 (2.3-6.0) cm away from the intestinal canal, and 5.21% (5/96) patients had poor anastomosis at the primary arch. Moreover, secondary vascular arches (6.4 (4.6-10.0) cm from the intestinal wall) were observed in 38.54% of patients. MA injury was identified in 2 of 183 cases, and the ischemic bowel was timely dissected, whereas no such injury occurred during ICG fluorescenceguided surgery. Guided by carbon nanoparticles, the integrity of lymph node dissection can be maintained while preserving the secondary arch in all patients. This study demonstrated the benefits of ICG guidance in protecting the intestinal blood supply in laparoscopic PCC surgery. By enhancing the understanding of primary and secondary vascular arches, secure windows, and dangerous triangles, surgeons can safely optimize the surgical path during surgery.

Influencing factors and nursing countermeasures of hypothermia in elder patients undergoing laparoscopic resection of colon cancer

Influencing factors and nursing countermeasures of hypothermia in elder patients undergoing laparoscopic resection of colon cancer

Possible Advantages of Minimal-Invasive Approaches in Rectal Cancer Surgery: A Nationwide Analysis.

(1) Background: Laparoscopic resection for colon and rectal cancer was introduced in the early 1990s; the aim of this analysis was to show possible advantages of minimal-invasive approaches in rectal cancer surgery. (2) Methods: From 2016 to 2020, all patients undergoing open, laparoscopic or robotic-assisted rectal cancer surgery in Germany were retrospectively analyzed regarding sex distribution, conversion rates and in-hospital mortality rates according to nationwide hospital billing data based on diagnosis-related groups (DRGs). (3) Results: In total, 68,112 patients were analyzed, and most commonly, low anterior rectal resections with primary anastomosis (n = 25,824) were performed with an increase of minimal-invasive procedures over the years (open: 51% to 27%; laparoscopic: 47% to 63% and robotic: 2% to 10%). In-hospital mortality rate was 2.95% (n = 2012). In total, 4.61%, 1.77%, 1.14% and 3.95% of patients with open, laparoscopic, robotic and converted-to-open surgery died during hospital stay, respectively (open vs. laparoscopic p < 0.0001; open vs. robotic p < 0.00001; laparoscopic vs. robotic p = 0.001). Conversion rates were significantly more favorable in the robotic compared to the laparoscopic group. (11.94% vs. 2.53%; p < 0.0001). (4) Conclusion: Minimal-invasive rectal cancer surgery might have some advantages in terms of a reduced in-hospital mortality, and an improved conversion rate for the robotic approach.

Prospective assessment of platelet function in patients undergoing elective resection of glioblastoma multiforme

This prospective study was aimed to test changes in hemostasis in patients with GBM, occurring at baseline (before surgery, time 0, T0) and 2 (T2), 24 (T24), and 48-hour (T48) after surgery. We enrolled consecutive patients subjected to GBM resection (GBR group; N = 60), laparoscopic colon cancer resection (comparative CCR group; N = 40), and healthy blood donors (HBD group; N = 40). We performed 1. conventional coagulation tests 2. ROTEM (rotational thromboelastometry) parameters and 3. platelet function tests, including PFA-200 closure time when stimulated by collagen/epinephrine (COL-EPI) and ROTEM platelet, using three different activators (arachnoid acid in ARATEM, adenosine diphosphate in ADPTEM, and thrombin receptor-activating peptide-6 in TRAPTEM). Variables associated with unfavorable 1-year clinical outcome were investigated, too. We observed in GBR patients that platelet aggregometry, as assessed by ROTEM platelet parameters, was significantly impaired along with a shortened closure time. These changes were evident from T0 to T48. A decreased area under the aggregation curve in TRAPTEM was associated with improved survival (adjusted odd ratio (95% CI), 1.03 (1.01–1.06)). This study suggests that patients with GBM presented a decreased platelet aggregation from before surgery and thorough the postoperative period. Decreased platelet aggregation improved clinical outcome.

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction.

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Feasibility of preservation of superior rectal artery plus dissection of lymph nodes around inferior mesenteric artery in laparoscopic resection for sigmoid colon cancer.

Limited data are available about superior rectal artery (SRA) preservation in laparoscopic resection for sigmoid colon cancer (SCC). This study aimed to evaluate the short-term and long-term efficacies of SRA preservation in laparoscopic radical resection for SCC. We retrospectively analyzed 207 patients with SCC who underwent laparoscopic radical resection for SCC from January 2017 to June 2021. A total of 84 patients received lymph node clearance around the inferior mesenteric artery (IMA) root (D3 lymph node dissection) with preservation of SRA (SRA preservation group), and 123 patients received high ligation of the IMA (control group). The clinicopathological data of the two groups were compared, and Kaplan-Meier method was performed to estimate patient survival. Compared with the control group, the operation time of the SRA preservation group was longer (p < 0.001), but the postoperative exhaust and defecation times were significantly shorter (p = 0.003, p < 0.001). Two cases of postoperative ileus and four cases of anastomotic leakage were observed in the control group, whereas the SRA preservation group had none. However, no statistical difference was observed between the groups (p = 0.652, p = 0.248). The overall survival also showed no significant difference in (p = 0.436). Preservation of SRA plus dissection of lymph nodes around IMA did not increase postoperative morbidity and mortality nor affect the prognosis of patients but increased the bowel blood supply, which may have a significant positive effect on the recovery of postoperative intestinal function and reduction of anastomotic leakage.

Prevention of ureteral injury during laparoscopic colorectal cancer surgery with horseshoe kidney using fluorescent ureteral catheters: a case report

BackgroundHorseshoe kidney is one of the most common congenital renal fusion anomalies and is characterized by abnormalities in the position, rotation, vascular supply, and ureteral anatomy of the kidney. When performing surgery for colorectal cancer in patients with horseshoe kidneys, anatomical identification is important to avoid organ injuries. Several reports on surgery for colorectal cancer with horseshoe kidneys have described the usefulness of three-dimensional (3D) computed tomography (CT) angiography for detecting abnormalities in vascular supply. However, few reports have focused on the prevention of ureteral injury in surgery for colorectal cancer with horseshoe kidney, despite abnormalities in the ureteral anatomy. Here, we report a case in which laparoscopic sigmoid colon resection for sigmoid colon cancer with a horseshoe kidney was safely performed using fluorescent ureteral catheters.Case presentationA 60-year-old Japanese man presented to our hospital testing positive for fecal occult blood. Colonoscopy revealed sigmoid colon cancer, and CT confirmed a horseshoe kidney. The 3D-CT angiography showed aberrant renal arteries from the aorta and right common iliac artery, and the left ureter passed across the front of the renal isthmus. A fluorescent ureteral catheter was placed in the left ureter before the surgery to prevent ureteral injury. Laparoscopic sigmoid colon resection with D3 lymph node dissection was performed. The fluorescent ureteral catheter enabled the identification of the left ureter that passed across the front of the renal isthmus and the safe mobilization of the descending and sigmoid colon from the retroperitoneum. The operative time was 214 min, with intraoperative bleeding of 25 mL. The patient’s postoperative course was good: no complications arose and she was discharged on the seventh postoperative day.ConclusionIn patients with horseshoe kidney, the use of fluorescent ureteral catheters and 3D-CT angiography enables safer laparoscopic surgery for colorectal cancer. We recommend the placement of fluorescent ureteral catheters in such surgeries to prevent ureteral injury.

SJLA_2024_A2: Laparoscopic Colectomy with Lymph Node Navigation and Intracorporeal Anastomosis using Double Indocyanine Green Technique

Introduction: In laparoscopic colectomy for colorectal cancer, appropriate lymph node dissection and prevention of anastomotic leak are very important. Indocyanine green (ICG) images obtained through the laparoscopic procedure helped visualize lymphatic drainage vessels and inform decision-making to determine the vessels. Intracorporeal anastomosis has advantages such as earlier recovery of postoperative bowel function, shorter length of wound incision, reduction of intestinal mobilization range, and fewer incisional hernias. Background: We report the surgical technique and short-term results of 48 patients who underwent laparoscopic colectomy and intracorporeal anastomosis using the double ICG fluorescence technique from July 2020 to September 2023. Methods: Two injections of ICG (0.75 mg ×2) into the proximal and distal subserosa of the tumor preceded the surgical procedure after pneumoperitoneum. Intraoperative lymph node mapping by the Stryker1588, 1688AIM camera imaging system was visualized. Laparoscopic colectomy was performed according to the Complete Mesocolic Excision and Central Vascular Ligation concepts. Complete intracorporeal anastomosis was performed by a functional end-to-end or overlap or Delta anastomosis. After anastomosis, ICG (12.5 mg) was injected intravenously to check the intestinal blood perfusion at the anastomosis site. Results: Forty-eight patients (Sex; male: 23 and female: 25) (Tumor location; C: 20, A: 11, T: 8, D: 7, S:2) (pStage0:2, I:15, II: 16, III:10, and IV:5) were underwent. The median age was 74. median body mass index was 23. Median number of dissected lymph nodes was 18. The median operative time was 246 min. The median wound length was 3.5 cm. The median postoperative hospital stay was 7 days. Visualization of lymphatic flow was observable in 24 of 28 cases (85.7%). The transection line was changed in 2/48 cases (4.1%) after ICG fluorescence angiography. There were no intraoperative complications, and two patients had postoperative paralytic ileus. Discussion: We introduce a novel technique of double ICG administration during laparoscopic colon resection for colon cancer that enables improved lymphadenectomy and warrants the extent of intestinal resection. It contains the intrinsic solution to the potential risks related to more intense dissection for extended lymphadenectomy. This is an immediate assessment of blood supply to the anastomosed intestinal walls. ICG fluorescence has immanent advantages as a result of its very low toxicity, high sensitivity, fast feedback, and absence of radiation. It is helpful to determine the extent of a bowel resection and can avoid leaving positive lymph nodes behind. It was revealed that ICG accurately evaluates the blood supply to anastomotic sites in real time and can detect organ ischemia before reconstruction is performed. This is particularly useful in laparoscopic surgery, as detection of impaired blood supply is difficult and even more for intracorporeal anastomosis. Lower anastomotic leak and reoperation rates were revealed with the use of ICG in several studies. Lymph nodes’ metastases are the most important prognostic factor in colon cancer, which has a poor prognosis and high recurrence. The use of ICG in the identification of lymph flow and lymphadenectomy basin in colon cancer patients has been previously reported. Lymph drainage of the transverse colon is complicated, and understanding this lymphatic drainage system is difficult, making ICG fluorescence particularly useful in right-sided and splenic flexure colon cancer patients. Conclusion: ICG fluorescence lymphangiography in laparoscopic colectomy for colon cancer allows visualization of lymphatic flow and may complement more reliable lymph node dissection. In addition, the evaluation of intestinal perfusion using ICG contributes to the reduction of anastomotic leakage and enables safer intracorporeal anastomosis.

Comparing the short-term results of the improved triangular anastomosis technique for complete laparoscopic radical resection of sigmoid colon cancer and laparoscopic-assisted small incision colon reconstruction: A CONSORT study.

The laparoscopic approaches using the triangular anastomosis technique for sigmoid colon cancer (SCC) are rare. This CONSORT study explored the short-term effects of laparoscopic radical resection of SCC with modified triangular anastomosis technique and laparoscopic-assisted small incision colon cancer reconstruction surgery. From April 2019 to January 2021, a total of 86 patients with SCC who were admitted to Luopu County People’s Hospital were selected and received radical resection. Patients were divided into 2 groups using a random number table method: in the control group, patients underwent laparoscopic-assisted small-incision reconstruction surgery, and patients in the observation group underwent complete laparoscopic surgery with modified triangular anastomosis technique. The 2 groups were compared in perioperative related indicators and postoperative complications. After 3 months follow-up, local tumor recurrence and metastasis, abdominal wall puncture and implantation, and death were observed. Compared to the control group, shorter operation time, gastrointestinal reconstruction time, postoperative exhaust time, hospitalization time, and less intraoperative blood loss, and lower probability of complications were observed in the observation group (P < .05). However, there was no significant difference in the number of lymph node dissections between the 2 groups (P > .05). After 3 months of follow-up, no local tumor recurrence, distant tumor metastasis, abdominal wall puncture implantation, and death were found in the 2 groups of patients. It is indicated that the improved triangular anastomosis technique for complete laparoscopic radical resection of SCC is effective in treatment for SCC.

Optimal Dose of Dexmedetomidine for Preemptive Analgesia Combined with Transversus Abdominis Plane Block after Colon Cancer Surgery.

Pain after colon cancer surgery can be effectively relieved by transversus abdominis plane (TAP) block. We aimed to determine the optimal dose of dexmedetomidine for preemptive analgesia when combined with TAP block after colon cancer surgery. A total of 120 patients undergoing laparoscopic resection for colon cancer from March 2018 to October 2019 were randomly assigned to control (group C), low-dose (group L, 0.5 μg/kg), moderate-dose (group M, 1 μg/kg), and high-dose groups (group H, 1.5 μg/kg) (n=30 each). After puncture under ultrasound guidance, the designated dexmedetomidine dose and 0.25% ropivacaine were injected on both sides (20 mL each side). Mean arterial pressure (MAP), heart rate (HR), numeric rating scale (NRS) score, and Ramsay score were compared at 2 h (T0), 4 h (T1), 8 h (T2), 12 h (T3), 24 h (T4), and 48 h (T5) after surgery. The area sensitive to mechanical stimulation-induced pain at the incision was measured at T4, T5, and 72 h after surgery (T6). Adverse reactions were compared. MAP and HR were lower in the dexmedetomidine groups, especially groups M and H, than in group C (P<0.05). NRS scores at T0-T5 and pain-sensitive areas at T4-T6 were lower in the dexmedetomidine groups than in group C (P<0.05), but Ramsay scores were similar (P>0.05). Compared with group L, groups M and H had lower NRS scores and pain-sensitive areas (P<0.05). The incidence rates of adverse reactions were lower in the dexmedetomidine groups than in group C (P<0.05). Dexmedetomidine 1 or 1.5 μg/kg is effective and did not increase adverse reactions. A dose of 1 μg/kg is recommended as an adjuvant to ropivacaine for TAP block.

Oncological outcomes of open, laparoscopic and robotic colectomy in patients with transverse colon cancer.

Literature concerning surgical management of transverse colon cancer is scarce, since many key trials excluded transverse colon cancer. The aim of this study was to evaluate clinical and oncological outcomes comparing open, laparoscopic and robotic transverse colon cancer resection. Consecutivepatients who underwent elective surgery for transverse colon cancer between December 2005 and July 2021 were included. Data were kept in a prospective database approved by the institutional ethics committee. Primary outcome was overall and disease-free survival. Secondary outcomes included complications, operative time, length of stay and lymph node harvest. Statistical analysis was corrected for age and tumour localisation. Two hundred and forty-six (38 robotic, 71 open and 137 laparoscopic resections) were recruited in this study. There were five conversions during laparoscopic procedures. Operative time was significantly shorter in robotic vs laparoscopic procedures (195 vs 238min, p = 0.005) and length of stay was shorter in robotic vs laparoscopic and open group (7 vs 9 vs 15days, p < 0.001). There was no difference in overall complications. R0 resections were similar. Lymph node harvest was highest in the robotic group vs. laparoscopic or open (32 vs. 29 vs. 21, p < 0.001). Overall survival was 97%, 85% and 60% (p < 0.001) and disease-free survival was 91%, 78% and 56% (p < 0.001) for the robotic, laparoscopic and open groups, respectively. Minimally invasive surgery for transverse colon cancer is safe and offers good clinical and oncological outcomes. Robotic resection is associated with significantly shorter operating times, higher lymph node harvest, lower conversion rate and does not increase morbidity. Differences in disease-free and overall survival should be further explored in randomised controlled trials.

Magnetic Resonance Imaging Characteristic Evaluation of Dexmedetomidine on Neurocognitive Dysfunction in Elderly Patients with Colorectal Tumors after Laparoscopic Operation.

In order to investigate the effects of Dexmedetomidine (DEX) on postoperative anesthesia recovery time and consciousness function in elderly patients with laparoscopic colorectal tumors, 40 patients (20 in the control group and 20 in the DEX group) were selected. The DEX group was intravenously pumped at a rate of 0.8 μg/kg/h for 10 min and then continuously pumped at a rate of 0.3 μg/kg/h until 40 min before the end of the operation. The two groups were given the same amount of normal saline, with the same way of anesthesia. The results showed that the visual analog scale (VAS) score of pain in the two groups decreased signally. Compared with the control group, the inflammatory factors tumor necrosis factor (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and macrophage inflammatory protein (MIP-2) in the DEX group were remarkably decreased at T1 and T2 stages, with a considerable difference (P < 0.05). One month after the auxiliary diagnosis of colorectal tumor, no clear nodular, irregular shape patches, or patchy diffuse limited points were found, which indicated that the whole tumor had been removed. In summary, DEX could improve postoperative cognitive function in elderly patients who underwent the laparoscopic radical resection of colon cancer, and its mechanism was related to the reduction of inflammatory factors. Therefore, the anesthesia intervention with DEX during the operation had a positive significance for tumor resection.

Totally laparoscopic resection of right-sided colon cancer using transvaginal specimen extraction with a 10-mm-long abdominal incision.

Natural orifice specimen extraction (NOSE) has been developed as a means of decreasing the incidence of surgical wound complications. We refined the procedure for totally laparoscopic colectomy with transvaginal specimen extraction using the reduced port surgery technique with the ultimate goal of attenuating damage to the abdominal wall. We herein report this innovative technique and its short- and long-term outcomes. We prospectively collected data on seven patients who underwent totally laparoscopic colectomy using transvaginal specimen extraction with a 10-mm-long abdominal incision for right-sided colon cancer from January 2014 to December 2021. Two 5-mm ports were used in the procedure without laparotomy. Transverse transabdominal posterior colpotomy was then performed. We introduced a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) into the transvaginal route for the insertion of a laparoscope, forceps, and stapling device. Lymph node dissection and transection of the ileum and distal colon were performed with transvaginal assistance. A specimen was then extracted transvaginally. Intracorporeal functional end-to-end anastomosis was conducted using a linear stapler through the vagina. After the removal of GelPOINT Mini, the vaginal incision was closed transvaginally. Seven patients successfully underwent this procedure. Median operative time was 219min (range 174-255min), median blood loss was 23ml (range 10-37ml), median number of harvested lymph nodes was 21 (range 17-35 lymph nodes) and median margins were17.0cm (range 9.0-25.0cm) for the proximal margin and 9.5cm (range 5.0-13.0cm) for the distal margin. There were no complications more severe than Clavien-Dindo Grade II and there was no mortality. The median frequency of use intravenous analgesics from postoperative day 1 to discharge was once. Two patients did not require analgesics. A node-positive patient developed recurrence at the lung and paraaortic lymph nodes. This procedure appears to be feasible, safe, and oncologically acceptable for selected cases.

Application of three-dimensional visualization technique in laparoscopic D3 radical resection of right colon cancer

To explore the clinical value of three-dimensional (3D) visualization technique in laparoscopic D3 radical resection of right colon cancer. We retrospectively analyzed the clinical data of 73 patients with right colon cancer undergoing laparoscopic D3 radical operation in our hospital between May, 2019 and March, 2021. Among these patients, 41 underwent enhanced CT examination with 3D visualization reconstruction to guide the actual operation, and 32 underwent enhanced CT examination only before the operation (control group). In 3D visualization group, we examined the coincidence rate between the 3D visualization model and the findings in surgical exploration of the anatomy and variations of the main blood vessels, supplying vessels of the tumor, and the tumor location, and the coincidence rate between the actual surgical plan for D3 radical resection of right colon cancer and the plan formulated based on the 3D model. The operative time, estimated blood loss, unexpected injury of blood vessels, number of harvested lymph nodes, mean time of the first flatus, complications, postoperative hospital stay and postoperative drainage volume were compared between the two groups. The operative time was significantly shorter in 3D visualization group than in the control group (P < 0.05). The volume of blood loss, proportion of unexpected injury of blood vessel, the number of harvested lymph nodes, time of the first flatus, proportion of complications, postoperative hospital stay and postoperative drainage volume did not differ significantly between the two groups (P > 0.05). In the 3D visualization group, the 3D visualization model clearly displayed the shape and direction of the colon, the location of the tumor, the anatomy and variation of the main blood vessels and the blood vessels supplying the cancer, and showed a coincidence rate of 100% with the findings by surgical exploration. The surgical plan for D3 radical resection of right colon cancer was formulated based on the 3D model also showed a coincidence rate of 100% with the actual surgical plan. The 3D visualization reconstruction technique allows clear visualization the supplying arteries of the tumor and their variations to improve the efficiency, safety and accuracy of laparoscopic D3 radical resection of right colon cancer.