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Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique

BACKGROUND: The aim of this study is to review our experience performing laparoscopic colon surgery and to present the operative technique as used and standardized by us. METHODS: From April 1992 to December 1996, 158 consecutive patients underwent laparoscopic colon surgery. There were 92 females a...

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Autores principales: Croce, E., Azzola, M., Russo, R., Golia, M., Olmi, S.
Formato: Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 1997
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016731/
https://www.ncbi.nlm.nih.gov/pubmed/9876674
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author Croce, E.
Azzola, M.
Russo, R.
Golia, M.
Olmi, S.
author_facet Croce, E.
Azzola, M.
Russo, R.
Golia, M.
Olmi, S.
author_sort Croce, E.
collection PubMed
description BACKGROUND: The aim of this study is to review our experience performing laparoscopic colon surgery and to present the operative technique as used and standardized by us. METHODS: From April 1992 to December 1996, 158 consecutive patients underwent laparoscopic colon surgery. There were 92 females and 66 males, whose average age was 66.7 years (range 31 - 92); 134 patients (84.9%) were operated on for carcinoma, and the remaining 24 (14.1%) for benign disease. RESULTS: There were 117 procedures completed laparoscopically out of 158 patients (74%); 103 colon resections (18 for benign disease and 95 for malignant disease), 7 Hartmann procedures, 3 for reversal of Hartmann's procedures, 1 rectopexy, and 3 ileotrasversostomies. Conversions were required in 41 out of 158 cases (25.9%); 19 of these cases, however, were converted to a laparoscopic-facilitated procedure. The most common causes for conversion were the presence of bulky tumors and/or tumors that contaminated adjacent structures (16/158), adhesions due to previous operations (8/158) or patient obesity (5/158). There were 31 complications (19.6%), 9 of which required re-operation. There was only one recurrence (0.9%) that manifested 15 months after the procedure, at both trocar and drainage sites, and with peritoneal carcinomatosis. This occurred in a patient with rectal neoplasia who suffered a perforation of the rectum during dis-section, with bowel spillage. The average number of lymph nodes harvested in resected specimens was 12.8 (range 1-41), whereas the mean distance of the tumor from the proximal margin of resection was 11.5 cm (range 5-35), and from the distal margin 7.5 cm (range 1-25). The average operative time was 165 minutes (range 40-360), and the mean hospital stay was 9.2 days (range 6-40). There were three mortalities out of 158 patients (1.9%). CONCLUSIONS: Laparoscopic colon resection for malignant lesions, performed with the highest respect for oncologic principles, has demonstrated that it is difficult to develop a barrier to wall and intraluminal recurrence. Recurrence, in our opinion, is caused by improper surgical technique. Therefore, neoplastic colon laparoscopic surgery must be the prerogative of selected and specialized centers.
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spelling pubmed-30167312011-02-17 Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique Croce, E. Azzola, M. Russo, R. Golia, M. Olmi, S. JSLS Scientific Papers BACKGROUND: The aim of this study is to review our experience performing laparoscopic colon surgery and to present the operative technique as used and standardized by us. METHODS: From April 1992 to December 1996, 158 consecutive patients underwent laparoscopic colon surgery. There were 92 females and 66 males, whose average age was 66.7 years (range 31 - 92); 134 patients (84.9%) were operated on for carcinoma, and the remaining 24 (14.1%) for benign disease. RESULTS: There were 117 procedures completed laparoscopically out of 158 patients (74%); 103 colon resections (18 for benign disease and 95 for malignant disease), 7 Hartmann procedures, 3 for reversal of Hartmann's procedures, 1 rectopexy, and 3 ileotrasversostomies. Conversions were required in 41 out of 158 cases (25.9%); 19 of these cases, however, were converted to a laparoscopic-facilitated procedure. The most common causes for conversion were the presence of bulky tumors and/or tumors that contaminated adjacent structures (16/158), adhesions due to previous operations (8/158) or patient obesity (5/158). There were 31 complications (19.6%), 9 of which required re-operation. There was only one recurrence (0.9%) that manifested 15 months after the procedure, at both trocar and drainage sites, and with peritoneal carcinomatosis. This occurred in a patient with rectal neoplasia who suffered a perforation of the rectum during dis-section, with bowel spillage. The average number of lymph nodes harvested in resected specimens was 12.8 (range 1-41), whereas the mean distance of the tumor from the proximal margin of resection was 11.5 cm (range 5-35), and from the distal margin 7.5 cm (range 1-25). The average operative time was 165 minutes (range 40-360), and the mean hospital stay was 9.2 days (range 6-40). There were three mortalities out of 158 patients (1.9%). CONCLUSIONS: Laparoscopic colon resection for malignant lesions, performed with the highest respect for oncologic principles, has demonstrated that it is difficult to develop a barrier to wall and intraluminal recurrence. Recurrence, in our opinion, is caused by improper surgical technique. Therefore, neoplastic colon laparoscopic surgery must be the prerogative of selected and specialized centers. Society of Laparoendoscopic Surgeons 1997 /pmc/articles/PMC3016731/ /pubmed/9876674 Text en © 1997 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Scientific Papers
Croce, E.
Azzola, M.
Russo, R.
Golia, M.
Olmi, S.
Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique
title Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique
title_full Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique
title_fullStr Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique
title_full_unstemmed Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique
title_short Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique
title_sort laparoscopic colectomy: the absolute need for a standard operative technique
topic Scientific Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016731/
https://www.ncbi.nlm.nih.gov/pubmed/9876674
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