What are the risks of laparoscopic colorectal surgery?

Complete mesocolic excision (CME) with central vascular ligation (CVL) is a potentially superior oncological technique in colon cancer surgery. The tenets of high vascular ligation at the origin and mesocolic dissection facilitate a greater lymph node yield. We present the case of a 70-year-old lady with chronic right iliac fossa discomfort. Computer tomographic scans showed a bulky ascending colon cancer with a 2.6cm right mesocolic lymph node. She underwent laparoscopic CME right hemicolectomy with CVL. Three operative trocars were used (a 12mm trocar in the left iliac fossa, 5mm ports in the left flank and right iliac fossa). Dissection begins in an inferior to superior approach, starting with mobilization of the ileocolic mesentery off the right common iliac vessels, then progressing to separate the mesentery off the duodenum and Gerota's fascia, exposing the head of the pancreas and the duodenal loop. CVL begins with the identification of the superior mesenteric vein (SMV). The vascular structures are isolated individually and ligated high at the level of the SMV, removing the metastatic right mesocolic node ‘en bloc’. Following proximal and distal transections, an intracorporeal ileo-transverse anastomosis is performed. Histology findings demonstrate the presence of a pT4a N2a M0 mucinous adenocarcinoma with 5 out of 17 lymph nodes (including the large mesocolic lymph node) positive for metastasis.

The video "Mesenteric lengthening plasty with multiple vascular divisions to perform ileoanal anastomosis and J pouch reservoir", authored by J Leroy and J Marescaux, is analysed by Dr. Feza H. Remzi, MD, FACS, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

Large colonic polyps and those on or behind a haustral fold can be very challenging to remove. EMR and ESD are performed for such polyps. In some selected cases, a combined endoscopic and laparoscopic approach (CELS) can be performed. In this lecture, Dr. Marcello outlines this approach.

The video "Three-port laparoscopic sigmoidectomy with transanal extraction for sigmoid diverticulitis ", authored by J Leroy and J Marescaux, is analysed by Dr. John Rowat Monson, MD, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

This video shows a unique procedure during which a sigmoidectomy was performed with a single trocar and entirely through the umbilicus. The principles applied to benign colonic resections are respected. An original colo-colonic anastomosis is presented with the use of external magnets to aid in with the totally intracorporeal anastomosis. The postoperative cosmetic results are shown.

This video demonstrates a laparoscopic closure of a Hartmann's 6 months after it was done for a perforated diverticular disease. The surgeon gains access to the peritoneal cavity through a port placed under direct vision in the right upper quadrant. The adhesions to the midline scar are taken down. The rectal stump is identified and mobilized proximally. The colostomy is then taken down and an end to end anastomosis is made with the rectum using an EEA stapler.

Colorectal anastomosis testing is mandatory. Air and color tests are most commonly performed. In this key lecture, Dr. Shamiyeh presents his experience with intraoperative endoscopic anastomosis testing.