ABSTRACT
Surgical treatment of low rectal cancer is a difficult point in colorectal surgery, which has the problem of mutual restriction between radical resection and functional protection. With the development of laparoscopic total mesenterectomy, minimally invasive operation through anal endoscopy and the gradual improvement of the concept of natural orifice transluminal endoscopic surgery, the transanal total mesorectal excision (taTME) is formed in line with the principle of radical resection of rectal cancer. On the premise of ensuring radical resection, taTME can maximize organ preservation and function protection, and improve the quality of life of patients. 4K laparoscopic system can provide a clear surgical field and improve the surgical precision, which is helpful for the accurate anatomy of low rectal cancer. The authors share the clinical experience of 4K laparoscopy assisted taTME in order to provide references for surgical colleagues.
ABSTRACT
Lateral lymph node metastasis (LLNM) is the main metastatic mode and the major cause of locoregional recurrence of mid-low rectal cancer. Single chemoradiotherapy cannot achieve good local control for LLNM, while the argument against performing lateral lymph node dissection (LLND) is the increased rate of urinary and sexual dysfunction after surgery. Ultra-high definition surgical field and delicate resolution by 4K laparoscopic surgical system will be helpful to achieve good tumor clearance and function preservation by identification and exposure of the important anatomic structures such as pelvic autonomic nerve and internal iliac vessels. Therefore, selective LLND can reduce local recurrence rates, particularly in the pelvic sidewall. LLND with autonomic nerve preservation by 4K laparoscopic system is expected to further decrease the risk of perioperative complications and urinary and sexual dysfunction in appropriate patients with neoadjuvant chemoradiotherapy.
ABSTRACT
Lateral lymph node metastasis (LLNM) is one of the major causes for post-operative local recurrence of middle and low rectal cancer. At present, there are still controversies on the diagnosis and treatment of LLNM. The radiological assessment of LLNM generally relies on morphological criteria such as the size or shape of the node or the response to therapy, in which the diagnostic accuracy of MRI is superior to that of other imaging techniques. Neoadjuvant chemoradiotherapy could not achieve good local control for suspicious LLNM. Lateral lymph node dissection (LLND) can reduce tumor local recurrence significantly, but the clinical value of LLND in survival and quality of life of patients has been questioned. 4K laparoscope can decrease the incidence of perioperative complications and urinary and sexual dysfunction to a certain extent. Thus, selective LLND should be undertaken to patients with suspicious LLNM after neoadjuvant chemoradiotherapy, in order to reduce tumor local recurrence and improve the prognosis of patients. The authors elaborate on diagnosis and treatment including surgery or chemoradiotherapy of LLNM in 4K laparoscopic surgery for middle and low rectal cancer combined with their own experiences.
ABSTRACT
Intersphincteric resection (ISR) is a limited sphincter preserving surgery for low rectal cancer. The 4K laparoscopic system has the advantage of enhancing the accurate recognition of anatomical structures for operators. The authors investigate the imaging evaluation and technical standard of 4K laparoscopic ISR of low rectal cancer through surgical examples.
ABSTRACT
With the development of laparoscopic techniques, the requirement of fine dissection in surgeons is also growing. Laparoscopic technique has the advantages in the choice of anatomical level and nerve vascular protection for surgery. 4K laparoscopy provides more clear field of vision and more detailed anatomic prerequisites. Combined with surgical examples, the authors share experiences in protection of plant nerve during 4K laparoscopic radical resection of colorectal cancer.
ABSTRACT
Colon cancer is a commonly malignant tumor with high morbidity and mortality in China, which seriously threatens human health and lives. Surgery plays a key role in the treatment of colorectal cancer so far. The sigmoid colon is the predilection site of colon cancer. Laparoscopic surgery has been gradually applied in radical operation of sigmoid colon cancer. 4K laparoscopy belongs to a kind of high-imaging technology, of which the information volume is more than 4 times that of conventional high-definition televisions. It can improve the operator's sense of control on the surgical field of view. Combined with team practical experience, the author introduces and interprets the excision extent and operative procedures in radical resection of mid-distal sigmoid colon cancer from the perspective of the 4K laparoscopy.
ABSTRACT
Laparoscopic radical resection of left hemicolon cancer is difficult in lymph node dissection, splenic flexure dissociation and digestive tract reconstruction. The high resolution recognition ability of 4K laparoscopic system can help complete mesocolic excision and neuroprotec-tion of the left colon. The authors discuss the key points of 4K totally laparoscopic radical resection of left hemicolon cancer and intraperitoneal overlap digestive reconstruction through surgical examples.
ABSTRACT
Colorectal cancer is the fourth most malignant tumors in China, among which the left hemicolon cancer accounts for about 5%?6%. Due to the complex anatomy around the left hemicolon, being adjacent to the pancreas, spleen, kidney, ureter and other important organs, its vascular and nerve distribution is variably distributed, leading difficulties in laparoscopic radical surgery for left hemicolon cancer. In surgical practice, the 4K laparoscopic system has shown its features of high-definition amplification, good color reproduction, and clear anatomy, etc. However, there is still no clear consensus on its application in the radical resection for the left hemicolon cancer. The authors summarize clinical practice, explore the technique key points of 4K laparoscopic D 3 resection with complete mesocolic excision for the left hemicolon cancer.
ABSTRACT
Laparoscopic radical resection of transverse colon cancer is a difficult operation, which is featured by large operation area, multiple steps, and many clinical anatomical variations. It requires the concept of complete mesocolic excision. Because of its absolute high-definition picture restoration, the 4K laparoscope can effectively assist in the identification, protection and severance of blood vessels during the operation, and assist in judging the fascia space of the operation. After entering Toldt fascial space through the intermediate approach guided by the superior mesenteric vein, the left, right transverse colon and lower area of mesangium are completely dissected, the upper area of colon, hepatic and splenic flexure are sepearted. The authors summarize practical experiences, investigate the extent of lymph node dissection in 4K laparoscopic radical resection of transverse colon cancer and share surgical experience.
ABSTRACT
In the implementation of laparoscopic D 3 radical resection of right colon cancer, the principle of tumor-free and complete mesenteric excision should be strictly followed. The whole lesion and lymph drainage area should be removed, and precise anatomy along the Toldt space should be performed to ensure sufficient incisional margin and complete lymph node dissection. Using 4K laparoscopy, the ultra-high definition picture is presented on the super large screen, which is more conducive to the surgeons to distinguish the anatomical plane and conduct accurate anatomy.
ABSTRACT
4K laparoscopy brings opportunities and challenges to the development of rectal surgery. 4K laparoscopy can truly provide the structure of abdominal and pelvic fascia, so that surgeons can see more subtle anatomical structure. The clear and real picture under 4K laparoscopic system can reduce visual fatigue of surgeons, which make the operation easier and safer. Radical resection of right colon cancer includes complete mesocolic excision and D 3 lymphadenectomy. Through 4K laparoscopic system, surgeons can easily observe the fascia structure of right mesocolon and its mesenteric bed, distinguish the vascular anatomical relationship at the mesenteric root, which make D 3 lymphadenectomy safer with dissection of lymph nodes completely. The authors comprehensively analyze the related research progress at home and abroad, and systematically elaborate the region of dissection and significance of 4K laparoscopic right hemicolectomy for right colon cancer.
ABSTRACT
With the development of laparoscopic technology, minimally invasive surgery has been popularized. The proportion of laparoscopic surgery in the surgical operations has gradually increased, which has become the standard operation for rectal cancer. In recent years, 4K imaging technology has been applied in laparoscopy, which enhanced the presentation of details of surgical field, improved the sense of operation of surgeons, and promoted the progress of laparoscopic technology. Attaching importance to the construction of surgery team of 4K laparoscopic rectal cancer, enhancing the cooperation between teams and improving the learning ability of the team will contribute to the popularization and application of 4K laparoscopy in rectal cancer surgery.
ABSTRACT
With the development of laparoscopic technology, surgeon's requirements for precise anatomy are gradually increasing. Laparoscopic system has great advantages in the selection of anatomical level, the protection of nerve and blood vessel in surgery. 4K laparoscopic system can provide high-definition vision of operative field, which is conducive to precise anatomical operation. The authors share the practical team cooperation experience of laparoscope left hemi-colectomy for colon cancer in order to provide references for surgical colleagues.
ABSTRACT
Colon cancer is one of the common digestive system tumors, and its incidence has an increased tendency. Comprehensive treatment based on surgery is still the current treatment. Although the laparoscopic technology of colorectal surgery in China has been rapidly developed in the past 30 years, there is no unified concept for the principles of colon cancer treatment, the scope of lymph node dissection is controversial, and the surgical approach is not unified. The author provides a detailed interpretation of the Chinese and Japanese laparoscopic colon cancer surgical dissection guidelines and technical standards based on Chinese Expert Consensus on Operation Standard of 4K Laparoscopic Surgery for Colorectal Cancer (2020 Edition), The Japanese Classification of Colorectal, Appendiceal and Anal Carcinoma (9th edition), The Guidelines for the Treatment of Colorectal Cancer (2019 edition) and Guideline for Operative Procedure of Laparoscopic Radical Resection of ColorectaI Cancer (2018 edition).
ABSTRACT
With the development of optical technology of laparoscopic equipment, the quality of surgical images has been greatly improved, which promote the rapid improvement of the quality of minimally invasive surgery for gastrointestinal tumors in Japan. In 2017, the editorial committee of Chinese Journal of Digestive Surgery organized gastroingestinal surgical experts from China and Japan to successfully hold the meeting of 'Interpretation of 4K Standardized Sino-Japanese Gastrointestinal Minimally Invasive Surgery', hoping to exchange, promote and popularize the medical technology of China and Japan in the field of laparoscopic gastrointestinal minimally invasive surgery. Through attending the meeting, the author′s team present 4K laparoscopic radical gastrectomy with autonomic nerve preservation and other surgical procedures, introduce the recognition standard of laparoscopic technology of the Japan Society for Endoscopic Surgery, and conduct in-depth discussion with Chinese surgeons on surgical technical points and oncology quality, so as to further promote the communication and cooperation between Chinese and Japanese surgeons in minimally invasive gastrointestinal surgery.
ABSTRACT
Laparoscopic gastrectomy has been widely applied in the surgical treatment for gastric cancer. The indications of laparoscopic gastrectomy for gastric cancer are also expanding. Based on the results of CLASS-01 study, laparoscopic distal gastrectomy is one of standard recommended surgical procedures for locally advanced gastric cancer. With the increased incidence of proximal gastric cancer and adenocarcinoma of esophagogastric junction, the proportion of total and proximal gastrectomy is gradually increasing. However, in consideration of tumor recurrence risk and severe gastroesophageal reflux symptoms after operation, the indication for proximal gastrectomy is more rigorous. Considering the minimally invasive advantage of laparoscopy, laparoscopic proximal gastrectomy is still an alternative surgical method for patients with surgical indications. It is well known that lymphadenectomy is the key procedure in stan-dard radical gastrectomy for gastric cancer. According to the Japanese gastric cancer treatment guideline of Japanese Gastric Cancer Association (JACA), the standard surgery of proximal gastrectomy is proximal gastrectomy combined with D 1 (No.1, 2, 3a, 4sa, 4sb, 7) or D 1+ (D 1+ No.8a, 9, 11p) lymphadenectomy. The authors describe the extent and procedure of lymphadenectomy and interpret technical standards for laparoscopic proximal gastrectomy.
ABSTRACT
The supra-pancreatic lymph node dissection is the key and difficult prospect in laparoscopic radical gastrectomy for gastric cancer. The 4K laparoscopic imaging technology can increase the recognition of blood vessels, nerves, lymph nodes and adipose tissue. Therefore, the detailed anatomy under the 4K laparoscopy can significantly reduce intraoperative bleeding and pancreatic injury, and accurately increase the determination of the scope and boundary of lymph node dissection. The authors discuss the supra-pancreatic lymph node dissection with the surgeon on left position in 4K laparoscopic radical gastrectomy.
ABSTRACT
Digestive tract reconstruction with side-to-side esophagojejunostomy is one of the most commonly used digestive tract reconstruction methods after laparoscopic total gastrectomy. It does not need an auxiliary incision. The linear stapler is used to directly enter the abdominal cavity through the Trocar to perform side-to-side anastomosis of esophagojejunostomy. The common hole can be closed by hand suture or linear stapler. 4K laparoscopy can present a clearer and more realistic view to the operators, so as to realize side-to-side esophagojejunostomy more accurately, to reduce the postoperative anastomo-tic related complications and improve the safety of the operation. This article will elaborate the technical key points and difficulties of esophagojejunostomy in 4K laparoscopic total gastrectomy, as well as the prevention and treatment of anastomotic related complications.
ABSTRACT
The unique multi perspective and magni-fying effect of laparoscopic surgery make gastric surgery more precise and minimally invasive. The technical innovation of 4K laparoscopy enable surgeons to understand the finer submicrostructure-membrane anatomy. The advantages of perigastric lymph node dissection with less trauma and bleeding under the guidance of membrane anatomy theory are widely recognized. As a common metastatic site of advanced distal gastric cancer, lymph nodes in the infrapyloric region play an important role in radical gastrectomy. Blood vessels variation is common in the inferior pyloric region, and the layer between gastric and mesenteric membrane is complex. Complete resection of the right gastric omentum membrane can yield greater surgical benefits. In this article, the author discuss the key points of lymph node dissection in the subpyloric region based on their surgical experience, aiming to promote the standard surgical procedure of 4K laparoscopic lymph node dissection in the inferior pyloric region based on membrane anatomy.
ABSTRACT
The laparoscopic vision platform developed from the prototype of candlelight reflector device to HD, 3D and 4K ultra HD, which revolutionized surgery from open surgery to minimally invasive surgery. With the continuous application in gastric cancer surgery, the importance of laparoscopy in radical gastrectomy is gradually recognized. Radical gastrectomy mainly includes lymph node dissection and digestive tract reconstruction. The reconstruction of digestive tract after radical gastrectomy for distal gastric cancer has been a hot topic of discussion and research, which is directly related to the incidence of postoperative complications, nutritional status and quality of life. This paper mainly discusses the Roux-en-Y digestive tract reconstruction of radical gastrectomy for distal gastric cancer with 4K laparoscopic.