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Laparoscopic sigmoidectomy in Germany—a standardised procedure?

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Abstract

Background

Laparoscopic resection of the sigmoid colon is generally considered as feasible option to open surgery, but standardised guidelines on surgical details have not been adopted yet. The aim of this survey was to investigate which techniques were applied by laparoscopic surgeons who are members of the Surgical Working Group for Minimal Invasive Surgery (CAMIC) of the German Surgical Society.

Materials and methods

In 2005, we conducted a written survey among all members of the CAMIC asking them for their routine surgical strategy of laparoscopic sigmoid resection in a standardised multiple-choice questionnaire. This questionnaire consisted of 20 questions covering main technical issues of laparoscopic sigmoid resection including trocar and team positioning, mobilisation and resection of the left colon, specimen retrieval as well as anastomosing technique. The results were classified into four levels of consensus depending on the level of agreement between participating surgeons.

Results

There were 292 surgeons who took part in the survey. Strong consensus (>95% agreement) was only found in 1 of 20 technical details: the operating surgeon standing at the patient right’s side. Consensus (75–95% agreement) was found for: position of the first assistant standing to the patient’s left side, size of the camera port is 10 mm, lateral mobilisation of the left hemicolon before ligating the inferior mesenteric artery, extracorporeal resection of the sigmoid via minilaparotomy, transrectal stapling of the colorectal anastomosis, intraoperative testing of the anastomosis for leakage, no regular suturing over the anastomosis and irrigating of the abdominal cavity after surgery.

Conclusions

Variability of technical details of laparoscopic sigmoidectomy was surprisingly high among German laparoscopic surgeons. This fact should be considered when discussing clinical studies about laparoscopic sigmoidectomy because trocar position, type of minilaparotomy and dissection techniques may very well influence patient outcome after laparoscopic surgery. Therefore, publications of clinical results concerning laparoscopic sigmoid resection should include a precise description of the technical details of the operation.

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Acknowledgment

We would like to thank Prof. Dr. med. Bittner and Prof. Dr. med. Köckerling for providing us with the contact of CAMIC members.

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Authors and Affiliations

  1. Department for General-, Visceral-, Vascular- and Thoracic Surgery, University Medicine Berlin-Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Jens Neudecker, Robert Bergholz, Tido Junghans, Julian Mall & Wolfgang Schwenk

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  1. Jens Neudecker
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  2. Robert Bergholz
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  3. Tido Junghans
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  4. Julian Mall
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  5. Wolfgang Schwenk
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Correspondence to Wolfgang Schwenk.

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Neudecker, J., Bergholz, R., Junghans, T. et al. Laparoscopic sigmoidectomy in Germany—a standardised procedure?. Langenbecks Arch Surg 392, 573–579 (2007). https://doi.org/10.1007/s00423-007-0172-7

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  • DOI: https://doi.org/10.1007/s00423-007-0172-7

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