Laparoscopic right colectomy: Miles away or just around the corner?

Marco Lotti, Michela Giulii Capponi, Luca Campanati, Paolo Bertoli, Fabrizio Palamara, Federico Coccolini, Luca Ansaloni, Marco Lotti, Michela Giulii Capponi, Luca Campanati, Paolo Bertoli, Fabrizio Palamara, Federico Coccolini, Luca Ansaloni

Abstract

Background: Despite the drive toward centralization of surgery in high-volume centers, the majority of colectomies are still performed by low- or medium-volume surgeons.

Materials and methods: A modification of the technique of laparoscopic right colectomy (LRC) originally described by Young-Fadok and Nelson was developed. The key points of that technique were maintained, but a different port-site layout and a counterclockwise approach were adopted, to warrant better trocar triangulation, to reduce the need of right colon manipulation and to avoid dissection along false planes. This modified technique was applied in 82 patients by 16 surgeons with no previous experience in LRC.

Results: Average operative time was 125 ± 35 min. Conversion occurred in 10 cases (12.2%). Grade III postoperative complications occurred in 3 patients (3.6%). No postoperative mortality was observed. Average number of lymph nodes retrieved was 19 ± 6. Average length of stay was 7 ± 4 days.

Conclusion: Providing low-volume surgeons with simplified and easy-to-learn surgical techniques could improve outcomes and lead to an increased use of laparoscopy.

Keywords: Colon cancer; laparoscopic right colectomy; learning; right colon; surgeon volume; surgical education.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Port site placement
Figure 2
Figure 2
Surgical steps
Figure 3
Figure 3
The final incision joins the epigastric and periumbilical port sites
Figure 4
Figure 4
Central vascular ligation through the midline incision

References

    1. Dijkstra FA, Bosker RJ, Veeger NJ, van Det MJ, Pierie JP. Procedural key steps in laparoscopic colorectal surgery, consensus through Delphi methodology. Surg Endosc. 2014 Dec 6; [Epub ahead of print] PMID: 25480611.
    1. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: Complete mesocolic excision and central ligation — Technical notes and outcome. Colorectal Dis. 2009;11:354–64.
    1. Søndenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H, et al. The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: Proceedings of a consensus conference. Int J Colorectal Dis. 2014;29:419–28.
    1. Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, et al. Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: Feasibility and technical strategies. Surg Endosc. 2012;26:3669–75.
    1. Siani LM, Pulica C. Laparoscopic Complete Mesocolic Excision with Central Vascular Ligation in right colon cancer: Long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery. Scand J Surg. 2014 Nov 12; pii: 1457496914557017 [Epub ahead of print] PMID: 25391978.
    1. Kang J, Kim IK, Kang SI, Sohn SK, Lee KY. Laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc. 2014;28:2747–51.
    1. Feng B, Ling TL, Lu AG, Wang ML, Ma JJ, Li JW, et al. Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer. Surg Endosc. 2014;28:477–83.
    1. Mori S, Baba K, Yanagi M, Kita Y, Yanagita S, Uchikado Y, et al. Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk for right colon cancer. Surg Endosc. 2015;29:34–40.
    1. Damle RN, Macomber CW, Flahive JM, Davids JS, Sweeney WB, Sturrock PR, et al. Surgeon volume and elective resection for colon cancer: An analysis of outcomes and use of laparoscopy. J Am Coll Surg. 2014;218:1223–30.
    1. Etzioni DA, Young-Fadok TM, Cima RR, Wasif N, Madoff RD, Naessens JM, et al. Patient survival after surgical treatment of rectal cancer: Impact of surgeon and hospital characteristics. Cancer. 2014;120:2472–81.
    1. Bardakcioglu O, Khan A, Aldridge C, Chen J. Growth of laparoscopic colectomy in the United States: Analysis of regional and socioeconomic factors over time. Ann Surg. 2013;258:270–4.
    1. Young-Fadok TM, Nelson H. Laparoscopic right colectomy: Five-step procedure. Dis Colon Rectum. 2000;43:267–71.
    1. Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH. Workload and surgeon's specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev. 2012;3:CD005391.
    1. Burns EM, Bottle A, Almoudaris AM, Mamidanna R, Aylin P, Darzi A, et al. Hierarchical multilevel analysis of increased caseload volume and postoperative outcome after elective colorectal surgery. Br J Surg. 2013;100:1531–8.
    1. Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Impact of hospital case volume on the quality of laparoscopic colectomy in Japan. J Gastrointest Surg. 2009;13:1619–26.
    1. Hopkins MA. Surgical education and global health: Call to action. Am J Surg. 2015;209:1–7.
    1. Benseler V, Hornung M, Iesalnieks I, von Breitenbuch P, Glockzin G, Schlitt HJ, et al. Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection. Int J Colorectal Dis. 2012;27:1521–9.
    1. Merlino J. Defining the volume-quality debate: Is it the surgeon, the center, or the training? Clin Colon Rectal Surg. 2007;20:231–6.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren