Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy — analysis of learning curves for a novice minimally invasive surgeon

Abstract

Background: Associated with reduced trauma, laparoscopic colon surgery is an alternative to open surgery. Furthermore, complete mesocolic excision (CME) has been shown to provide superior nodal yield and offers the prospect of better oncological outcomes.Methods: All oncologic laparoscopic right colon resections with CME performed by a single surgeon since the beginning of his surgical practice were retrospectively analyzed for operative duration and perioperative outcomes. Results:The study included 81 patients. The average duration of surgery was 220.0 (range 206-233) minutes. The initial durations of about 250 minutes gradually decreased to less than 200 minutes in an inverse linear relationship (y = -0.58x × 248). The major complication rate was 3.6% ± 4.2% and the average nodal yield was 31.3 ± 4.1. CumulativeSum analysis showed acceptable complication rates and oncological results from the beginning of surgeon's laparoscopic career. Conclusion:Developing laparoscopic skills can provide acceptable outcomes in advanced right hemicolectomy for a surgeon who primarily trained in open colorectal surgery. Operative duration is nearly triple that reported for conventional laparoscopic right hemicolectomy. The slow operative duration learning curve without a plateau reflects complex anatomy and the need for careful dissection around critical structures. Should one wish to adopt this strategy either based on some available evidence of superiority or with intention to participate in research, one has to change the view of right hemicolectomy being a rather simple case to being a complex, lengthy laparoscopic surgery.Contexte : La chirurgie du côlon par laparoscopie, qui réduit les traumatismes, est une solution de rechange à la chirurgie ouverte. De plus, il a été démontré que l'excision mésocolique complète (EMC) optimise le curage ganglionnaire et offre la perspective de meilleurs résultats oncologiques. Méthodes :On a examiné rétrospectivement la durée de l'opération et les résultats périopératoires de toutes les résections du côlon droit réalisées par laparoscopie avec EMC pratiquées par un seul chirurgien depuis le début de sa carrière.Résultats : L'étude a été menée auprès de 81 patients. La durée moyenne de l'intervention chirurgicale était de 220 minutes (intervalle de 206 à 233 minutes). Au début, l'intervention durait environ 250 minutes; avec le temps, sa durée a progressivement diminué de sorte qu'à la fin, elle était de moins de 200 minutes, d'après une relation linéaire négative (y = -0,58x × 248). Le taux de complications graves s'est établi à 3,6 % ± 4,2 % et le nombre moyen de noeuds lymphatiques excisés a été de 31,3 ± 4,1. En utilisant la méthode d'analyse des sommes cumulées, on a observé un taux de complications et des résultats oncologiques acceptables depuis le début de la carrière du chirurgien en laparoscopie. Conclusion :En perfectionnant sa technique laparoscopique, un chirurgien formé principalement en chirurgie colorectale ouverte peut produire des résultats acceptables dans les cas d'hé...

Medial versus lateral approache in laparscopic right hemicolectomy

“…Yong et al, show significant difference regarding post operative complication as p<0.05. Xu et al, show that There were significant differences in complications during surgery (p=0.008), minor postoperative complications (p=0.005), major postoperative complications (p=0.001), and agreeded by Senagore et al and Veldkamp et al [19][20][21][22] Regarding number of LN harvested in Table 4, This study show statistically significant difference between group A, group B and group C regarding number of lymph nodes harvested as p value is 0.005, Duck et al 23 The average nodal yield of 31.3 is consistent with previously published reports of 30 lymph nodes with MA group and is superior to average yields of fewer than 20 lymph nodes with LA group, and West et al 24 [25][26][27] In this study, laparoscopic combined and MA for resection of right side colon reduces the operative duration, intraoperative blood loss which decrease the postoperative proinflammatory which result in reduction in time of intestinal recovery and MA surgery good shortterm results including faster postoperative recovery, shorter hospitalization time, fewer intra and postoperative complications so MA was safe and feasible and this is supported by Poon, et al 28 Dayn and Lau reported anumber of advantages for this approach. They reported a reduced conversion rate for medial-to-lateral group.…”

Prognosis of patients with colonic carcinoma before, during and after implementation of complete mesocolic excision

“…In the present study, less than 2 per cent of patients had laparoscopy‐assisted surgery. Laparoscopic CME is possible with similarly large specimens, although this does not guarantee a higher node count. Both approaches require surgical skills and optimal pathological examination.…”

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

“…The steep learning curve was also emphasized by Melich et al in their experience with laparoscopic right hemicolectomy and CME. 49 While the literature on robotic CME remains sparse, several authors have commented on the potential for its development, citing its stable camera platform and precise instrumentation. [50][51][52][53] Using the older dV Si, Trastulli et al showed in their series of 20 patients how a surgeon at the beginning of his learning curve for robotic right hemicolectomy managed to complete all cases without conversion or intraoperative morbidity, and achieve a mean hospital stay of 4.5 days (range, 3.5-7).…”