ABSTRACT
Laparoscopic surgery has been accepted as an optimal treatment for colon cancer. Digestive tract reconstruction may be performed using extracorporeal anastomosis or intracor-poreal anastomosis after radical colectomy of colon cancer. More and more studies have compared both procedures, but the selection of optimal method of digestive tract reconstruction is still controversial. The authors conduct a systematic review on the application and research advances of intracorporeal anastomosis in laparoscopic surgery for colon cancer, investigate the technical skills of intracorporeal anastomosis and its clinical outcomes, so as to provide valid information for its clinical application.
ABSTRACT
The robotic surgical system applied to gastrectomy is regarded as a safe technique which has similar short- and long-term outcomes compared to laparoscopic and open gastrectomy. With the iteration of anastomotic staplers and improvement of anastomotic skills, coupled with the flexible robot's rotatable device making the manual intracorporal anastomosis easier, gastrointestinal reconstruction after robotic gastrectomy has also started to move toward the era of complete intracorporal anastomosis. In order to further standardize the indications and operating points, the Upper Gastrointestinal Surgery Group of Surgical Branch of Chinese Medical Doctor Association, the Gastrointestinal Surgery Group of Surgery Branch of Chinese Medical Association, the Digestive Tract Cancer Committee of Chinese Research Hospital Association, and Cancer Gastroenterology Society of Chinese Anticancer Association jointly organized domestic experts in general surgery field to formulate the Chinese expert consensus on intracorporal digestive reconstruction after robotic gastrectomy (2021 edition). The definition of intracorporeal digestive reconstruction after robotic gastrectomy is that all surgical steps of digestive reconstruction are done totally in the abdominal cavity by robotic system or all steps mentioned above except jejunojejunal extracorporeal anastomosis. The digestive reconstructions mainly include Billroth I anastomosis, Billroth II anastomosis, Billroth II+ Braun anastomosis, Roux-en-Y anastomosis, Uncut Roux-en-Y anastomosis after distal gastrectomy; double-tract anastomosis, esophagogastric anastomosis by stapler or hand-sewn technique (double flap gastroesophagostomy) after proximal gastrectomy; FEEA method, π-type anastomosis, overlap method and modified procedures, Uncut Roux-en-Y anastomosis, Parisi's double-loop reconstruction after total gastrectomy. Compared with extracorporeal digestive reconstruction, intracorporeal digestive reconstruction operated by robotic system can minimize the surgical incision, reduce the risk of abdominal exposure and accelerate postoperative recovery, etc. Previous studies have demonstrated promising results. We believe that the publication of the consensus will guide surgeons to break through the technical barriers of intracorporeal digestive reconstruction after robotic gastrectomy, which will be more and more widespread with the gradual maturity of domestic robotic systems by bringing less medical costs.
Subject(s)
Humans , China , Consensus , Gastrectomy , Robotic Surgical Procedures , Robotics , Stomach Neoplasms/surgeryABSTRACT
PURPOSE: A delta-shaped anastomosis (DA) is a widely accepted technique used for a totally laparoscopic distal gastrectomy (TLDG). Several studies have suggested various modifications to overcome the drawbacks of an original DA. We present our novel technique―a T-shaped modified delta anastomosis (TDA), and we report the early outcomes with its use in a case series. METHODS: We retrospectively reviewed the medical records of 40 patients who underwent a TLDG with TDA for early gastric cancer at OOO between February 2016 and May 2017. Perioperative outcomes, postoperative complications, and operating time were analyzed, and all data were expressed as means±standard deviation. RESULTS: We observed no major complications that required immediate postoperative intervention. Other minor and non-surgical complications were delayed gastric emptying (n=1), pneumonia (n=2), atelectasis (n=3), dumping symptom (n=1), and symptomatic bile reflux (n=1). No wound infection was reported in any patient. The total operative time was 206.5±25.4 min and the estimated blood loss was 27.8±33.5 ml. The mean time required to perform the anastomosis was 20.9±6.7 min, and the mean number of cartridges used during the operation was 4.78±0.66. CONCLUSION: We conclude that a TDA following a laparoscopic distal gastrectomy was successfully developed and showed acceptable clinical outcome.
Subject(s)
Humans , Bile Reflux , Gastrectomy , Gastric Emptying , Laparoscopy , Medical Records , Operative Time , Pneumonia , Postoperative Complications , Pulmonary Atelectasis , Retrospective Studies , Stomach Neoplasms , Wound InfectionABSTRACT
Objective@#The aim of this study was to explore the clinical safety and feasibility of intracorporeal delta-shaped anastomosis in total laparoscopic left hemicolectomy.@*Methods@#From January 1, 2017 to October 1, 2017, 11 patients who were diagnosed with left colon cancer and underwent total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis were retrospectively enrolled in this study. Clinicopathologic characteristics, surgical and postoperative outcomes were collected and analyzed.@*Results@#The median operation time was 121.8 minutes and the median time for anastomosis was 14.9 minutes. The median intraoperative blood loss was 45.5 ml. The lengths of the upper and lower segments of resection from colon cancer were 11.4 cm and 8.5 cm, respectively. The median number of lymph nodes retrieved was 29.5. The median time to ground activities, time to flatus, time to fluid diet intake and length of hospital stay were 1.4 days, 3.0 days, 3.8 days and 6.9 days, respectively. Only one patient suffered from incision infection during his hospitalization due to preoperative long-term smoking history. No mobility related to the anastomosis such as anastomotic bleeding, stenosis, obstruction and leakage occurred in any patients.@*Conclusion@#Total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis is a safe and feasible procedure with a satisfactory short-term effect.
ABSTRACT
Antecedentes: el abordaje laparoscópico en el tratamiento de las afecciones colorrectales ha demostrado numerosas ventajas en relación con la cirugía convencional; sin embargo, la necesidad frecuente de tener que emplear una incisión complementaria para la extracción de la pieza operatoria u otros gestos quirúrgicos genera efectos adversos vinculados con el dolor posoperatorio, íleo y las complicaciones propias de la herida. Objetivo: análisis de una serie de pacientes intervenidos por afecciones colorrectales mediante abordaje laparoscópico en quienes se realizó anastomosis intracorpórea comparada con otra de anastomosis extracorpórea. Material y métodos: entre abril de 2010 y mayo de 2013 fueron operados 85 pacientes con afecciones colorrectales, abordados por vía laparoscópica, los que se agruparon en dos lotes: Grupo 1, con anastomosis extracorpórea, 50 (58,8%) y Grupo 2, con variante intracorpórea, 35 (41,2 %). Resultados: no hubo diferencias entre ambos grupos (extracorpórea/intracorpórea), en cuanto a sexo (F/M:23/27, 22/13, respectivamente; p=0,052), edad promedio en años (63/60; p=0,222), índice de masa corporal (24,38 kg/m2/27,37 kg/m2; p=0,315), ASA (p=0,817), tpo de afección tratada (p= 0,312), sector resecado (p=0,282), longitud de la pieza operatoria (p=0,384) y cantidad de ganglios extrpados (p=0,537). Tampoco se hallaron diferencias en relación con la conversión, 7 (14%) versus 4 (11,4%), p= 0,379; tempo operatorio en minutos, (178,3 min/188,6 min), p= 0,257; complicaciones, 12 (24%/) versus 8 (22,8%), p= 0,493 y reoperaciones, 5 (10%) versus 4 (11,4%), p= 1. En ambos grupos no hubo mortalidad. Hubo diferencias en relación con el tamaño promedio en centmetros de la incisión empleada (7,7 cm/4,4 cm; p= 0,042) y el dolor posoperatorio inmediato (4,7/3,1; p=0,022). Conclusiones: la confección de anastomosis intracorpórea ofrece un menor dolor posoperatorio, con una menor herida quirúrgica y mejor estética, e iguales resultados posoperatorios inmediatos y alejados.
Background: the laparoscopic approach for the treatment of colorectal diseases has shown many ad-vantages over conventonal surgery. However, the frequent need of an additonal incision to extract the specimen or to perform further surgical techniques may cause adverse efectis related to postope-rative pain, ileus and complicatons of the wound. Objective: to compare a series of patentis undergoing laparoscopic surgery for colorectal disease with intracorporeal versus extracorporeal anastomosis. Material and methods: between April 2010 and May 2013, 85 patentis who were operated on lapa-roscopically for colorectal disease, were divided in two groups. Group I, extracorporeal, 50 (58.8%) and Group II, intracoroporeal anastomosis, 35 (41.2%). Results: there was no diference between groups in terms of gender (F/M-23/27, 22/13, p=0.052), mean age (63/60 years, p=0.222), body mass index (24.38 vs. 27.37 kg/m2), p = 0.315, ASA (p = 0.817), type of disease (p=0.312), resected segment (p=0.282), specimen length (p=0,384) and number of removed lymph nodes (p=0,537). No diferences were found in relaton to conversion, 7 (14%) vs. 4 (11.4%) p=0.379, operative tme (178.3 vs. 188,6 min), p=0.257, complicatons 12 (24% /) vs. 8 (22.8%) p=0.493 and reoperatons, 5 (10%) vs. 4 (11.4%;), p=1. No mortality occurred in both groups. There were diferences in the average size of the incision (7.7 cm vs. 4.4 cm, p = 0.042) and immediate postoperative pain (4.7 vs. 3.1, p = 0.022). Conclusions: laparoscopic approach with intracorporeal anastomosis for colorectal disease ofers less postoperative pain, a smaller wound and beter cosmetic result, with equal postoperative outicome.
ABSTRACT
In recent years,laparoscopic total gastrectomy (LTG) with lymphadenectomy is increasingly utilized for the management of gastric cancer located in the middle or upper third of the stomach.However,esophagojejunostomy is the key technical difficulty in operation.Compared with conventional extracorporeal esophagojejunostomy via mini-laparotomy,pioneers are attempting to perform intracorporeal anastomosis in order to gain better manipulation and minimally invasive benefits,as well as reducing the difficulties in digestive tract reconstruction.
ABSTRACT
Laparoscopic gastrectomy has become widely used as a minimally invasive technique for the treatment of gastric cancer. When it was first introduced, most surgeons preferred a laparoscopic-assisted approach with a minilaparotomy rather than a totally laparoscopic procedure because of the technical challenges of achieving an intracorporeal anastomosis. Recently, with improved skills and instruments, several surgeons have reported the safety and feasibility of a totally laparoscopic gastrectomy with intracorporeal anastomosis. This review describes the recent technical advances in intracorporeal anastomoses using circular and linear staplers that allow for totally laparoscopic distal, total, and proximal gastrectomies. Data that demonstrate advantages in early surgical outcomes of a total laparoscopic method compared to laparoscopic-assisted operations are also discussed.
Subject(s)
Gastrectomy , Laparotomy , Stomach NeoplasmsABSTRACT
PURPOSE: We wanted to evaluate the technical feasibility and safety of totally laparoscopic total gastrectomy (TLTG) for treating early gastric cancer. MATERIALS AND METHODS: The medical records of 11 consecutive patients who underwent TLTG after being diagnosed with early gastric cancer at Incheon St. Mary's Hospital, The Catholic University of Korea from February 2005 to September 2009 were retrospectively reviewed and their clinicopathologic characteristics and the surgical results were investigated. RESULTS: The mean operation time was 385.6+/-94.1 minutes, the mean time for creating an intracorporeal anastomosis was 97.5+/-60.0 minutes and the mean number of the harvested lymph nodes was 46.6+/-15.4. The mean number of days after operation until starting a liquid diet was the 6.15+/-7.6th postoperative day and the mean hospital stay after surgery was 14.2+/-11.9 days. There was no case of open conversion, but there were 2 cases of intraoperative complication and 3 cases of postoperative complication. There was one case of postoperative mortality. The patient suffered from thrombocytopenia of an unknown cause, which was refractory to platelet transfusion, on 4th postoperative day and the patient died of intraabdominal bleeding on the 6th postoperative day. CONCLUSION: TLTG was a technically feasible and relatively safe procedure. However, a long time for creating the intracoproeal anastomosis and a long operation time are still problems to be solved.
Subject(s)
Humans , Diet , Gastrectomy , Hemorrhage , Intraoperative Complications , Korea , Length of Stay , Lymph Nodes , Medical Records , Platelet Transfusion , Postoperative Complications , Retrospective Studies , Stomach Neoplasms , ThrombocytopeniaABSTRACT
PURPOSE: In Korea, the number of laparoscopy-assisted distal gastrectomies for early gastric cancer patients has been on the increase. Although minimally invasive surgery is more beneficial, no reported case of a total laparoscopic gastrectomy has been reported because of difficulty with intracorporeal anastomosis. This study attempts, through our experience, to determine the safety and feasibility of a total laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linears stapler in treating early gastric carcinomas. MATERIALS AND METHODS: We investigated the surgical results and clinicopatholgical characteristics of 81 patients that underwent a totally laparoscopic distal gastrectomy at our department between June 2004 and May 2007. The intracorporeal anastomoses were performed by using laparoscopic linear staplers. RESULTS: The mean operative time was 287 minutes, the mean anastomotic time was 40 minutes, and the mean number of laparoscopic linear staplers used for an operation was 7.5. The mean time to the first flatus, the first food intake, and discharge from hospital was 2.9, 3.6, and 10.3 days respectively. There were 11 cases of postoperative complications, but no case of postoperative mortality or conversion to an open procedure. In 75 patients with an adenocarcinoma, the mean number of lymph nodes harvested was 38.1 and the stage distribution was as follows: stage I, 72 patients; stage II, 2 patients; stage IV, 1 patient. During the mean follow-up period of 14 months, 5 patients died of other causes and there were no cases of cancer recurrence. CONCLUSION: A total laparoscopic gastrectomy with intracorporeal anastomosis by using a laparoscopic linear stapler was found to be safe and feasible. We were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.