Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score–weighted Cohort Study

Hsu, Yu-Jen; Chern, Yih-Jong; Jhuang, Jing-Rong; Tsai, Wen‐Sy; Chiang, Jy-Ming; Hung, Hsin-Yuan; Tsai, Tzong-Yun; You, Jeng-Fu

doi:10.1097/sle.0000000000000884

Cited by 11 publications

(6 citation statements)

References 41 publications

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“…Subsequently, we intended to perform a complete mesocolic excision and central vascular ligation. The left colic artery, left branch of middle colic artery, and inferior mesenteric vein were ligated using the Hem-o-lok system (Weck Closure Systems, Research Triangle Park, NC, USA) after completely dividing the mesentery of the planned resected bowel, including the marginal artery [ 11 ]. Colocolic anastomosis was performed using either EA or IA based on the surgeon’s preference.…”

Section: Methodsmentioning

confidence: 99%

Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy

et al. 2022

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Background Few studies have evaluated the feasibility and safety of intracorporeal anastomosis (IA) for left hemicolectomy. Here, we aimed to investigate the potential advantages and disadvantages of laparoscopic left hemicolectomy with IA and compare the short- and medium-term outcomes between IA and extracorporeal anastomosis (EA). Methods We retrospectively analyzed 133 consecutive patients who underwent laparoscopic left hemicolectomies from July 2016 to September 2019 and categorized them into the IA and EA groups. Patients with stage 4 disease and conversion to laparotomy or those lost to follow-up were excluded. Postoperative outcomes between IA and EA groups were compared. Short-term outcomes included postoperative pain score, bowel function recovery, complications, duration of hospital stay, and pathological outcome. Medium outcomes included overall survival and disease-free survival for at least 2 years. Results After excluding ineligible patients, the remaining 117 underwent IA (n = 40) and EA (n = 77). The IA group had a shorter hospital stay, a shorter time to tolerate liquid or soft diets, and higher serum C-reactive protein level on postoperative day 3. There was no difference between two groups in operative time, postoperative pain, specimen length, or nearest margin. A 2-year overall survival (IA vs. EA: 95.0% vs. 93.5%, p = 0.747) and disease-free survival (IA vs. EA: 97.5% vs. 90.9%, p = 0.182) rates were comparable between two groups. Conclusions Laparoscopic left hemicolectomy with IA was technically feasible, with better short-term outcomes, including shorter hospital stays and shorter time to tolerate liquid or soft diets. The IA group had higher postoperative serum C-reactive protein level; however, no complications were observed. Regarding medium-term outcomes, the overall survival and disease-free survival rates were comparable between IA and EA procedures.

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Section: Methodsmentioning

confidence: 99%

Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy

et al. 2022

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“…The standard technique for laparoscopic left hemicolectomy uses four ports and a medial-to-lateral surgical strategy as previously described (Figure 1) [12]. After bowel resection, all bowel anastomoses are created via side-to-side intracorporeal anastomosis, either isoperistaltic or antiperistaltic.…”

Section: Me Thodmentioning

confidence: 99%

Transrectal natural orifice specimen extraction in left hemicolectomy for tumours around the splenic flexure: Old wine in new bottles

et al. 2021

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Aim: Laparoscopic anterior resection with natural orifice specimen extraction (NOSE) has favourable short-term outcomes. However, NOSE is rarely adopted for left hemicolectomy procedures. This study aimed to review the feasibility, safety and short-term outcomes of transrectal NOSE in patients undergoing laparoscopic left hemicolectomy. Method: All consecutive patients who underwent laparoscopic left hemicolectomy surgery with transrectal NOSE in a single institution between January 2018 and December 2020 were reviewed. Transrectal NOSE was performed with an enterotomy at the upper rectum. The specimen was brought out via a transanal endoscopic microsurgery scope inserted through the anus. A supplementary video demonstrates this technique. Surgical outcomes, including complications, postoperative short-term recovery and the level of pain intensity, are presented.Results: Twenty patients were reviewed. There were no immediate postoperative complications and no wound infections in these patients. The average time to tolerate a soft diet was 3.6 days, and the average postoperative hospital stay was 4.5 days. The average score on the numerical rating scale of postoperative pain was 3.0 on postoperative day 1. The median follow-up time was 23.5 months. Conclusion:Laparoscopic left hemicolectomy with transrectal NOSE is a safe and feasible procedure that leads to early postoperative recovery and a short hospital stay.

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“…The standard techniques for laparoscopic left hemicolectomy involve the use of four ports and a medialto-lateral surgical approach, as previously mentioned (24). The procedure begins by clearly identifying and dividing the inferior mesenteric vein at its roots.…”

Section: Operative Proceduresmentioning

confidence: 99%

Cutting-Edge Strategies in Minimal Invasive Left Hemicolectomy for Tumors around the Splenic Flexure: Analyzing the Short-term Outcomes Between Transrectal Natural Orifice Specimen Extraction and Conventional Laparoscopy

Jong,

Hsu,

Chern

et al. 2024

Preprint

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Background The short-term outcomes of laparoscopic anterior resection with natural orifice specimen extraction (NOSE) are favorable. NOSE is, however, rarely used during left hemicolectomy surgeries. We retrospectively compared the feasibility, safety, and short-term results of transrectal NOSE for patients undergoing laparoscopic left hemicolectomy with conventional mini-laparotomy specimen extraction.Methods All patients who received laparoscopic left hemicolectomy surgery between January 2018 and December 2021, including 144 who underwent conventional surgery with specimen extraction through mini-laparotomy and 23 who underwent transrectal NOSE surgery, were enrolled in a single hospital. Surgical outcomes were assessed, including complications, postoperative short-term recovery, and pain level.Results The NOSE group had a shorter operation time, earlier postoperative recovery, a lower degree of pain on postoperative day 1, and a shorter hospital stay compared with the conventional group. In addition, postoperative morbidity was not noted in the transrectal NOSE group but was found in seven patients in the conventional group.Conclusion Laparoscopic left hemicolectomy with transrectal NOSE is a safe and feasible technique that results in quicker postoperative recovery and a shorter hospital stay. The advantages of transrectal NOSE compared to traditional mini-laparotomy in laparoscopic left hemicolectomy are being conducted for the first time in this study.

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Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score–weighted Cohort Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 41 publications

Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy

Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy

Transrectal natural orifice specimen extraction in left hemicolectomy for tumours around the splenic flexure: Old wine in new bottles

Cutting-Edge Strategies in Minimal Invasive Left Hemicolectomy for Tumors around the Splenic Flexure: Analyzing the Short-term Outcomes Between Transrectal Natural Orifice Specimen Extraction and Conventional Laparoscopy

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