Clinical Experiences with Laparoscopic Colectomy

Abstract

The indications for laparoscopic colon resection and the associated complications are discussed herein. This procedure was indicated for patients with benign disease or malignant disease with invasion limited to the submucosal layer. The subjects consisted of 14 cases with submucosal tumor invasion diagnosed preoperatively, three with submucosal invasion clarified by endoscopic polypectomy, three with adenomas larger than 2 cm in diameter strongly suspected of being focal submucosal tumor invasion considered unsuitable for endoscopic mucosal resection and one with Crohn's disease with ileus. Two cases in whom laparoscopic surgery was not appropriate were included in this series. In one case with a superficial elevated lesion (Ila type), 15 mm in diameter, a diagnosis of moderately differentiated adenocarcinoma of the cecum was made preoperatively, but subserosal tumor invasion of the colonic wall with negative lymph node metastasis (no) was revealed by examination of the resected specimen. The histology of the second superficial elevated lesion (Ha+ Ilc type), which had a central depression, 13 mm in diameter and located above Bauhin's valve, was a well differentiated adenocarcinoma of which the cancerous portion invaded the proper muscle with positive lymph node metastasis (n 1 ). Complications occurred in four cases. There were two cases of intraoperative vascular injury necessitating conversion to a standard laparotomy. One case with complete transection of the left ureter by End-GIA later underwent reoperation. The other case with minor leakage at the anastomotic site was managed with conservative therapy. In both of these cases the depth of tumor invasion had been incorrectly assessed as representing small elevated lesions, 15 mm in diameter, in the right colon. Furthermore, the cases who experienced complications had left colonic lesions. These results suggest that preoperative ultrasonic-endoscopy should be conducted as extensively as possible and that a good bloodless visual field appears to be necessary to avoid injuring adjacent organs. (Dig Endosc 1997 ; 9 : 1 1-1 5) words : colorectal cancer, laparoscopic colectomy, laparoscopy-assisted colectomy, laparoscopy, minimally invasive surgery Manuscript Surgery, Chelsea & Westminster Hospital, London), for their valuable advice, and would also like to thank Miss Dina Stanford for her help with the manuscript.

Efficacy of hybrid 2-port hand-assisted laparoscopic surgery (Mukai's operation) for patients with primary colorectal cancer

“…Less invasive surgery such as laparoscopy-assisted colorectal surgery (LACS) has become popular in recent years, and its indications have expanded markedly from additional resection in patients with stage I colorectal cancer to radical resection in patients with stage II/III cancer and palliative surgery for patients with advanced stage IV disease (1)(2)(3)(4)(5). Unlike Western countries, where hand-assisted laparoscopic surgery (HALS) and hybrid HALS combined with open manipulation are performed (6)(7)(8)(9), the main type of surgery employed in Japan is pure LACS with 5-6 ports including a camera port for manipulation and a small incision of 35-45 mm (10)(11)(12).…”

Hybrid 2-port hand-assisted laparoscopic surgery for the 2-stage treatment of a complete bowel obstruction by distal sigmoid colon cancer: A case report

“…In recent years, the indications for LACS have been based on different standards at each institution, covering a very wide range from stage I to stage IIIa (N1 lymph node metastasis involving ≤3 nodes) or stage IIIb tumors, or even palliative operations for stage IV cancer (1)(2)(3)(4)(5). In Western countries, radiation therapy is often administered concomitantly to patients with advanced lower rectal cancer (25)(26)(27).…”

“…The indications for LACS cover a very wide range, from additional procedures after endoscopic mucosal resection (EMR) of stage I early colorectal cancer to curative resection of stage II/III cancer and palliative surgery for advanced stage IV cancer (1)(2)(3)(4)(5). Unlike in the West, LACS in Japan does not usually involve hand-assisted laparoscopic surgery (HALS) or hybrid HALS combined with a standard procedure under direct vision (6)(7)(8)(9).…”

Anal function-preserving subtotal intersphincteric resection/partial external sphincteric resection with hybrid 2-port hand-assisted laparoscopic surgery (Mukai's operation) for very low stage I rectal cancer: A case report

“…In recent years, the use of minimally invasive laparoscopyassisted colorectal surgery (LACS) has become relatively common (1)(2)(3)(4)(5). Pure LACS using 5-6 ports with a small incision of 35-45 mm in length is mainly employed in Japan, and has been adopted for a wide variety of operations, including additional surgery for stage I colorectal cancer, curative resection of stage II/III colorectal cancer and palliative procedures for stage IV cancer (1)(2)(3)(4)(5).…”

“…Pure LACS using 5-6 ports with a small incision of 35-45 mm in length is mainly employed in Japan, and has been adopted for a wide variety of operations, including additional surgery for stage I colorectal cancer, curative resection of stage II/III colorectal cancer and palliative procedures for stage IV cancer (1)(2)(3)(4)(5). However, it is significantly more difficult to perform laparoscopic surgery for low rectal cancer than for colon cancer, and the indications and surgical methods vary among institutions.…”