Laparoscopic colorectal anastomosis: risk of postoperative leakage

Köckerling, F.; Rose, J; Schneider, Claus; Scheidbach, H.; Scheuerlein, H.; Reymond, Marc A.; Reck, T.; Konradt, J.; Bruch, Hans–Peter; Zornig, C.; Bärlehner, E.; Kuthe, A.; Szinicz, G.; Richter, H. A.; Hohenberger, Werner

doi:10.1007/s004649901064

Cited by 124 publications

(77 citation statements)

References 29 publications

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“…A second German study group, the Laparoscopic Colorectal Surgery Group, was formed in 1995 with the aim to produce scientifically evaluable data from German-speaking countries in Europe. 285 In 1999 they published results from a large multicentre observational study of laparoscopic and laparoscopically assisted colorectal anastomoses and the associated risk of postoperative anastomotic leak, based on data from 24 surgical centres in Germany, Austria and Switzerland. Anastomotic leak was one of the most common postoperative complications, with 46 clinical leaks from 949 anastomoses (5%).…”

Section: Reissman and Co-workersmentioning

confidence: 99%

The measurement and monitoring of surgical adverse events

Bruce

Russell

Mollison

et al. 2001

Health Technol Assess

298

209

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK.We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTAThe measurement and monitoring of surgical adverse events NHS R&D HTA ProgrammeT he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS.Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme.Although the National Coordinating Centre for Health Technology Assessment (NCCHTA) commissions research on behalf of the Methodology Programme, it is the Methodology Group that now considers and advises the Methodology Programme Director on the best research projects to pursue.The research reported in this monograph was funded as project number 97/16/04.The views expressed in this publication are those of the authors and not necessarily those of the Methodology Programme, HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit supp...

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Section: Reissman and Co-workersmentioning

confidence: 99%

The measurement and monitoring of surgical adverse events

Bruce

Russell

Mollison

et al. 2001

Health Technol Assess

298

209

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“…Furthermore, visualization of the procedure on a two-dimensional screen diminishes the hand-eye coordination by compromising the natural eye-hands-target axis [11,12,13]. Although many surgical procedures of the digestive tract are performed by endoscopic techniques routinely, elaborate interventions such as esophagus resection and biliodigestive reconstruction require extensive training and, due to these technical challenges, remain in the hands of a relatively small number of experts [14,15,16,17]. …”

Section: Introductionmentioning

confidence: 99%

Robot-Assisted Endoscopic Surgery: A Four-Year Single-Center Experience

Ruurda¹,

Draaisma²,

Hillegersberg³

et al. 2005

Dig Surg

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Background: Robotic systems were introduced in the late 1990s with the objective to overcome the technical limitations of endoscopic surgery. In this prospective cohort study the potential safety, feasibility, pitfalls and challenges of robotic systems in gastrointestinal endoscopic surgery are assessed and our vision on future perspectives is presented. Methods:Between August 2000 and December 2004, 208 procedures were performed with support of the Intuitive Surgical da Vinci™ robotic system. We started with cholecystectomies (40) and Nissen fundoplications (41) to gain experience with robot-assisted surgery. In the following years more complex procedures were carried out, i.e. colorectal procedures (7), type III/IV paraesophageal hernia repair (32), redo Nissen fundoplications (9), Heller myotomies (24), esophageal resections (22), rectopexies (16) and aortobifemoral bypasses (3). Results:The median robotic set-up time was 13 min, and 7 min in the last 50 procedures. The median operating time for the total of procedures was 120 min (45–420) and the median blood loss was 30 ml (0–800). Fourteen procedures were converted to open surgery (6.7%). Equipment-related problems, such as start-up failures and positioning difficulties of the robotic arms, were encountered in 11 cases (5.3%). Postoperative complications were seen in 11 patients (11/176, 6.3%) after robot-assisted laparoscopic procedures. Pulmonary complications occurred in 11 patients, cardiac in 3, anastomic leakage in 3, chylous leakage in 3 and vocal cord paralysis in 3 after thoracoscopic esophagolymphadenectomy for esophageal cancer. One patient died 12 days after esophageal resection (0.5%). Conclusion:During the implementation of this robotic system, we experienced an obvious learning curve, particularly with regard to the positioning of the robot cart and communication between the surgeon and operating team. After 4 years, we have experienced that the merits of the current generation of this technology probably is preserved to complex endoscopic procedures with delicate dissection and suturing. In the nearby future we will focus on the treatment of motility disorders and malignancies of the esophagus and stomach. The position of the robot in the endoscopic operating room will have to be clarified by the outcome of prospective research. Furthermore, priorities have to be acclaimed on technical sophistication and cost reduction of these systems.

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“…Auch hier zeigt sich eine gute Korrelation zu den Daten, wie sie aus der konventionellen Chirurgie bekannt sind [12].…”

Section: Komplikationsraten Der Laparoskopischen Chirurgieunclassified

Komplikationen der laparoskopischen kolorektalen Chirurgie unter besonderer Berücksichtigung der Anastomoseninsuffizienzrate. Literaturüberblick und Ergebnisse der Multizenterstudie «Laparoskopische Kolorektale Chirurgie»

Scheuerlein¹,

Schneider²,

Scheidbach³

et al. 2001

Visc Med

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Complications of Laparoscopic Colorectal Surgery in Considering the Anastomotic Insufficiency Rate. Literature Review and Results of the Multicenter Study ''Laparoscopic Colorectal Surgery'' Currently, about 5% of all colorectal operations in German-speaking countries are carried out with the laparoscopic modality. The most common of these interventions is resection of the sigmoid colon. In terms of postoperative morbidity, the minimally invasive approach has been found to be of advantage. In the case of operations for colorectal carcinoma, however, laparoscopic interventions continue to provoke controversial discussion. Patients being considered for a laparoscopic intervention first have to meet comparatively strict general and oncological selection criteria. The literature reports global morbidity rates of up to 60% for conventional, and up to 40% for laparoscopic, colorectal surgery. For conventional colorectal surgery, the anastomotic insufficiency rates for colon and upper rectum reported in the literature are up to 9%, with appreciably higher rates associated with the lower rectum. Studies on laparoscopic colorectal surgery identify anastomotic insufficiency rates of up to 7.5%, again with higher rates being reported for the low rectal anastomoses. Within the study group `Laparoscopic Colorectal Surgery'', an intra-operative complication rate of 5.5% and a global postoperative complication rate of 21.6% were found. The conversion rate was 5.3%, the anastomotic insufficiency rate 4.1%, the overall mortality rate 1.6%. When the appropriate selection criteria are applied, laparoscopic colorectal interventions are associated with a low postoperative morbidity rate, similar to, or lower than, that achieved with conventional colorectal surgery. Against this background, the feasibility and safety of laparoscopic colorectal anastomoses can be considered to have been unequivocally demonstrated. Currently, however, laparoscopic procedures cannot be considered the gold standard of colorectal surgery, since oncological considerations in particular render this operative modality inaccessible to the majority of patients.

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Laparoscopic colorectal anastomosis: risk of postoperative leakage

Cited by 124 publications

References 29 publications

The measurement and monitoring of surgical adverse events

The measurement and monitoring of surgical adverse events

Robot-Assisted Endoscopic Surgery: A Four-Year Single-Center Experience

Komplikationen der laparoskopischen kolorektalen Chirurgie unter besonderer Berücksichtigung der Anastomoseninsuffizienzrate. Literaturüberblick und Ergebnisse der Multizenterstudie «Laparoskopische Kolorektale Chirurgie»

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