Advertisement

Colorectal Surgery

  • Shuodong Wu
  • Ying Fan
  • Yu Tian
Chapter

Abstract

Since a case series on laparoscopic colectomy was firstly published in 1991 (Jacobs et al., Surg Laparosc Endosc 1:144–150, 1991), various randomized controlled trials (RCTs), non-RCTs and other types of studies had been performed, focusing on the evaluation of feasibility and safety of laparoscopic colorectal surgeries. Several meta-analyses and systematic reviews basing on RCTs and non-RCTs related to the comparison of laparoscopic and laparotomic colorectal surgeries have been established, finding out that laparoscopic surgery for colorectal cancer was non-inferior to laparotomy in terms of overall survival (Martel et al., PLoS One 7:e35292, 2012), short-term and long-term of oncological outcomes (Huang et al., Int J Colorectal Dis 26:415–421, 2011; Ma et al., Med Oncol 28:925–933, 2011), and also with shorter post-operative hospital stay (Lourenco et al., Surg Endosc 22:1146–1160, 2008). No significant differences were identified in the occurrence of major surgical complications but were associated with lower overall morbidity and minor complication rate in the management of diverticulitis (Siddiqui et al., Am J Surg 200:144–161, 2010; Cirocchi et al., Colorectal Dis 14:671–683, 2012) in the laparoscopic groups.

Substantially, laparoendoscopic single-site colorectal surgery (SILSC) is an evaluation of traditional multiport laparoscopic colorectal surgery (MLC), offering the minimally invasive advantages and cosmetic advantages over MLC with a single incision typically hidden in the umbilicus (Lu et al., Colorectal Dis 14:e171–e176, 2012). It has been applied to several colorectal procedures successfully, including right hemicolectomy, total colectomy, proctocolectomy with ileal pouch anal anastomosis, and left colectomy (Lu et al., Colorectal Dis 14:e171–e176, 2012; Chen et al., Surg Endosc 25:1887–1892, 2011; Kim et al., Ann Surg 254:933–940, 2011; Lai et al., Colorectal Dis 14:1138–1144, 2012; Papaconstantinou and Thomas, Surgery 150:820–827, 2011; Fujii et al., Surg Endosc 26:1403–1411, 2012; Poon et al., Surg Endosc 26:2729–2734, 2012; Ramos-Valadez et al., Surg Endosc 26:96–102, 2012; Rijcken et al., Dis Colon Rectum 55:140–146, 2012; Huscher et al., Am J Surg 204:115–120, 2012; Lee et al., Dis Colon Rectum 54:1355–1361, 2011; Waters et al., Dis Colon Rectum 53:1467–1472, 2010; Champagne et al., Dis Colon Rectum 54:183–186, 2011; Champagne et al., Ann Surg 255:66–69, 2012; Adair et al., Dis Colon Rectum 53:1549–1554, 2010; Gaujoux et al., J Gastrointest Surg 16:629–634, 2012; Kanakala et al., Tech Coloproctol 16:423–428, 2012; McNally et al., Surg Endosc 25:3559–3565, 2011; Wolthuis et al., Colorectal Dis 14:634–641, 2012; Papaconstantinou et al., J Am Coll Surg 213:72–80, 2011). A deceased post-operative pain score was reported, which might be due to the reduced number of lateral ports, thus decreasing post-operative discomfort (Champagne et al., Dis Colon Rectum 54:183–186, 2011; Chambers et al., Colorectal Dis 13:393–398, 2011). Additionally, the lower cost (McNally et al., Surg Endosc 25:3559–3565, 2011; Chambers et al., Colorectal Dis 13:393–398, 2011), faster recovery (Chambers et al., Colorectal Dis 13:393–398, 2011), decreased length of the largest incision (Lu et al., Colorectal Dis 14:e171–e176, 2012; Fujii et al., Surg Endosc 26:1403–1411, 2012; Lee et al., Dis Colon Rectum 54:1355–1361, 2011; Zhou et al., Dig Dis Sci 57:2103–2112, 2012), and diminished risk of incisional hernias (Ramos-Valadez et al., Surg Endosc 26:96–102, 2012) were also reviewed.

Though no criteria of contraindications for SILSC has been created, emergent condition, T4 tumors, history of abdominal surgery, morbid obesity, poor American Society of Anesthesiologists class or large size of malignant disease may act as risk factors for the performance of SILSC (Chen et al., Surg Endosc 25:1887–1892, 2011; Kim et al., Ann Surg 254:933–940, 2011; Ramos-Valadez et al., Surg Endosc 26:96–102, 2012; Huscher et al., Am J Surg 204:115–120, 2012; Waters et al., Dis Colon Rectum 53:1467–1472, 2010).

Though with potentially higher overall conversion rate, SILSC may be more feasible and safe in experienced hands if the patients are carefully selected, especially for malignancies. SILSC will benefit the patients more with its superiority over MLC.

Keywords

Cecectomy Terminal ileum resection Ileocolic anastomosis Line of Toldt Right hemicolectomy Gerota’s fascia Toldt’s fascia Tranverse colectomy Sigmoidectomy Colorectal anastomosis Rectal Carcinoma Dixon Technique Miles Technique Artificial anus Pancolectomy Ileosigmoid anastomosis Appendectomy 

References

  1. 1.
    Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1:144–50.PubMedGoogle Scholar
  2. 2.
    Martel G, Crawford A, Barkun JS, Barkun JS, Boushey RP, Ramsay CR, Fergusson DA. Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials. PLoS One. 2012;7:e35292.PubMedCrossRefGoogle Scholar
  3. 3.
    Huang MJ, Liang JL, Wang H, Huang MJ, Liang JL, Wang H, Kang L, Deng YH, Wang JP. Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis. 2011;26:415–21.PubMedCrossRefGoogle Scholar
  4. 4.
    Ma Y, Yang Z, Qin H, Wang Y. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. Med Oncol. 2011;28:925–33.PubMedCrossRefGoogle Scholar
  5. 5.
    Lourenco T, Murray A, Grant A, McKinley A, Krukowski Z, Vale L. Laparoscopic surgery for colorectal cancer: safe and effective? – A systematic review. Surg Endosc. 2008;22:1146–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Siddiqui MR, Sajid MS, Qureshi S, Cheek E, Baig MK. Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis. Am J Surg. 2010;200:144–61.PubMedCrossRefGoogle Scholar
  7. 7.
    Cirocchi R, Farinella E, Trastulli S, Sciannameo F, Audisio RA. Elective sigmoid colectomy for diverticular disease. Laparoscopic vs open surgery: a systematic review. Colorectal Dis. 2012;14:671–83.PubMedCrossRefGoogle Scholar
  8. 8.
    Lu CC, Lin SE, Chung KC, Rau KM. Comparison of clinical outcome of single-incision laparoscopic surgery using a simplified access system with conventional laparoscopic surgery for malignant colorectal disease. Colorectal Dis. 2012;14:e171–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Chen WT, Chang SC, Chiang HC, Lo WY, Jeng LB, Wu C, Ke TW. Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc. 2011;25:1887–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC, Oh ST. The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg. 2011;254:933–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Lai C, Edwards T, Clements D, Coleman M. Single port laparoscopic right colonic resection using a ‘vessel-first’ approach. Colorectal Dis. 2012;14:1138–44.PubMedCrossRefGoogle Scholar
  12. 12.
    Papaconstantinou HT, Thomas JS. Single-incision laparoscopic colectomy for cancer: assessment of oncologic resection and short-term outcomes in a case-matched comparison with standard laparoscopy. Surgery. 2011;150:820–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Fujii S, Watanabe K, Ota M, Watanabe J, Ichikawa Y, Yamagishi S, Tatsumi K, Suwa H, Kunisaki C, Taguri M, Morita S, Endo I. Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case–control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost. Surg Endosc. 2012;26:1403–11.PubMedCrossRefGoogle Scholar
  14. 14.
    Poon JT, Cheung CW, Fan JK, Lo OS, Law WL. Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc. 2012;26:2729–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Ramos-Valadez DI, Ragupathi M, Nieto J, Patel CB, Miller S, Pickron TB, Haas EM. Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series. Surg Endosc. 2012;26:96–102.PubMedCrossRefGoogle Scholar
  16. 16.
    Rijcken E, Mennigen R, Argyris I, Senninger N, Bruewer M. Single-incision laparoscopic surgery for ileocolic resection in Crohn’s disease. Dis Colon Rectum. 2012;55:140–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Huscher CG, Mingoli A, Sgarzini G, Mereu A, Binda B, Brachini G, Trombetta S. Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. Am J Surg. 2012;204:115–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Lee SW, Milsom JW, Nash GM. Single-incision versus multiport laparoscopic right and hand-assisted left colectomy: a case-matched comparison. Dis Colon Rectum. 2011;54:1355–61.PubMedCrossRefGoogle Scholar
  19. 19.
    Waters JA, Guzman MJ, Fajardo AD, Selzer DJ, Wiebke EA, Robb BW, George VV. Single-port laparoscopic right hemicolectomy: a safe alternative to conventional laparoscopy. Dis Colon Rectum. 2010;53:1467–72.PubMedCrossRefGoogle Scholar
  20. 20.
    Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP. Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum. 2011;54:183–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Champagne BJ, Papaconstantinou HT, Parmar SS, Nagle DA, Young-Fadok TM, Lee EC, Delaney CP. Single-incision versus standard multiport laparoscopic colectomy: a multicenter, case-controlled comparison. Ann Surg. 2012;255:66–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Adair J, Gromski MA, Lim RB, Nagle D. Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport laparoscopic right colectomy. Dis Colon Rectum. 2010;53:1549–54.PubMedCrossRefGoogle Scholar
  23. 23.
    Gaujoux S, Maggiori L, Bretagnol F, Ferron M, Panis Y. Safety, feasibility, and short-term outcomes of single port access colorectal surgery: a single institutional case-matched study. J Gastrointest Surg. 2012;16:629–34.PubMedCrossRefGoogle Scholar
  24. 24.
    Kanakala V, Borowski DW, Agarwal AK, Tabaqchali MA, Garg DK, Gill TS. Comparative study of safety and outcomes of single-port access versus conventional laparoscopic colorectal surgery. Tech Coloproctol. 2012;16:423–8.PubMedCrossRefGoogle Scholar
  25. 25.
    McNally ME, Todd Moore B, Brown KM. Single-incision laparoscopic colectomy for malignant disease. Surg Endosc. 2011;25:3559–65.PubMedCrossRefGoogle Scholar
  26. 26.
    Wolthuis AM, Penninckx F, Fieuws S, D’Hoore A. Outcomes for case-matched single-port colectomy are comparable with conventional laparoscopic colectomy. Colorectal Dis. 2012;14:634–41.PubMedCrossRefGoogle Scholar
  27. 27.
    Papaconstantinou HT, Sharp N, Thomas JS. Single-incision laparoscopic right colectomy: a case-matched comparison with standard laparoscopic and hand-assisted laparoscopic techniques. J Am Coll Surg. 2011;213:72–80; discussion 80–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Chambers WM, Bicsak M, Lamparelli M, Dixon AR. Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis. 2011;13:393–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Zhou YM, Wu LP, Zhao YF, Xu DH, Li B. Single-incision versus conventional laparoscopy for colorectal disease: a meta-analysis. Dig Dis Sci. 2012;57:2103–12.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Shuodong Wu
    • 1
  • Ying Fan
    • 1
  • Yu Tian
    • 1
  1. 1.Minimal Invasive Surgery and Bile Duct Surgery Shengjing HospitalChina Medical UniversityShenyangChina

Personalised recommendations