Laparoscopic Colorectal Surgery - Belgian Group of Endoscopic ... [PDF]

12th Edition - Starters Package in Laparoscopy IRCAD/EITS Strasbourg (France) – October 20+21, 2011. Teacher : Prof. Dr. André D’Hoore – UZ Gasthuisberg Leuven

Laparoscopic Colorectal Surgery part I. Colon A.D’Hoore MD PhD, A. Wolthuis MD F. Penninckx MD,PhD Department of abdominal Surgery University Hospital Leuven

Laparoscopic assisted right hemicolectomy Schlinkert RT Dis Colon Rectum 1991 ; 34 : 1030 - 1031

Laparoscopic Colon Surgery.

1

12th Edition - Starters Package in Laparoscopy IRCAD/EITS Strasbourg (France) – October 20+21, 2011. Teacher : Prof. Dr. André D’Hoore – UZ Gasthuisberg Leuven

Q. I personally performed 1. 0 laparoscopic colorectal resections 2. < 10 3. < 20 4. > 20

Q. my personal exposure during training 1. 0 laparoscopic colorectal resections 2. < 20 3. < 50 4. > 50

Laparoscopic Colon Surgery.

2

12th Edition - Starters Package in Laparoscopy IRCAD/EITS Strasbourg (France) – October 20+21, 2011. Teacher : Prof. Dr. André D’Hoore – UZ Gasthuisberg Leuven

A complex journey facilitated – gasless – hand assisted later to medial , medial to lateral

Port – site metastasis : learning curve - effect Called for a temporary moratorium ( 1994-1999)

< 1995 : 0.6 – 21 % >1995 / n = 1.769 0.85 %

Laparoscopic Colon Surgery.

3

12th Edition - Starters Package in Laparoscopy IRCAD/EITS Strasbourg (France) – October 20+21, 2011. Teacher : Prof. Dr. André D’Hoore – UZ Gasthuisberg Leuven

Q. Laparoscopy for colonic cancer 1. Oncologic outcome beter than open 2. Same oncologic outcome but short-term benefit 3. Same oncologic outcome but short-term and long-term benefit 4. Only a cosmetic benefit

Hazard Ratio : disease free survival at 3 years Ration

Kuhry et aL. Lapsc. Surgery for colonic cancer - PhDThesis

Laparoscopic Colon Surgery.

4

12th Edition - Starters Package in Laparoscopy IRCAD/EITS Strasbourg (France) – October 20+21, 2011. Teacher : Prof. Dr. André D’Hoore – UZ Gasthuisberg Leuven

morbidity (meta-analysis)

Laparoscopic Colon Surgery.

5

12th Edition - Starters Package in Laparoscopy IRCAD/EITS Strasbourg (France) – October 20+21, 2011. Teacher : Prof. Dr. André D’Hoore – UZ Gasthuisberg Leuven

Hospital Stay: multifactorial Lacy COLOR I COST CLASSIC

2002 2005 2005 2005

colon rectum Senagore et al.

2005

laparoscopic 5.2 8.2 5

open 7.9 9.3 6

9 11 3.7

9 13

p 0.005 2 attacks ) Trend towards a more conservative approach

- Internal fistulae (15%) - Diagnostic doubt (ca) - (recurrent bleeding)

Laparoscopic Colon Surgery.

12

12th Edition - Starters Package in Laparoscopy IRCAD/EITS Strasbourg (France) – October 20+21, 2011. Teacher : Prof. Dr. André D’Hoore – UZ Gasthuisberg Leuven

Common fistulas -Bladder Foley cathether 5-7 d

-Vagina (after HRT ) -Small bowel

Q. Sigmoid resection for diverticulitis 1. Resection is limited to the inflamed zone 2. All proximal diverticulae should be included in the resection (I will extend my resection to the transverse colon if needed) 3. The distal margin is more important than the proximal margin (I will deliberately leave diverticulae behind)

Laparoscopic Colon Surgery.

13

12th Edition - Starters Package in Laparoscopy IRCAD/EITS Strasbourg (France) – October 20+21, 2011. Teacher : Prof. Dr. André D’Hoore – UZ Gasthuisberg Leuven

resection margins in diverticular disease Importance distal resection margin : colo-rectal anastomosis 12.5 % (distal sigmoid) vs 6.7 % rectum (p