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3D laparoscopic left colectomy with intraoperative colonoscopy: a live educational procedure
In this live educational procedure, Dr. Armando Melani presents the case of a 70-year-old female patient with a previous history of inferior right lobectomy secondary to T2 carcinoma. In 2018, during postoperative surveillance, PET-scan showed a left colon fixation. Colonoscopy revealed a polypoid lesion located 40cm away from the anal verge. Biopsy showed severe dysplasia. Endoscopic clips were placed for marking purposes. Three additional adenomatous polyps in the right, transverse, and left colon were found and removed. Preoperative abdominal X-ray showed the presence of clips at the level of the left pelvic bone. Since colonoscopy was performed more than two weeks before surgery, intraoperative colonoscopy was used to ensure tumor location.

During the video, surgical pitfalls were highlighted, and the author showed the importance of preoperative tumor tattooing, demonstrated anatomical landmarks, and the starting point of mesenteric dissection for left colectomy at the superior mesenteric vein (IMV). Recommendations for inferior mesenteric artery (IMA) ligation, hypogastric nerve preservation, splenic flexure mobilization, stapling recommendations during colon transection, colorectal anastomosis, and means to prevent postoperative complications were provided. The value of leak test, endoscopic anastomosis evaluation, and the use of indocyanine green (ICG) were also emphasized.
A Melani, A D'Urso, R Rodriguez Luna, D Mutter, J Marescaux
Surgical intervention
6 days ago
175 views
8 likes
0 comments
17:09
3D laparoscopic left colectomy with intraoperative colonoscopy: a live educational procedure
In this live educational procedure, Dr. Armando Melani presents the case of a 70-year-old female patient with a previous history of inferior right lobectomy secondary to T2 carcinoma. In 2018, during postoperative surveillance, PET-scan showed a left colon fixation. Colonoscopy revealed a polypoid lesion located 40cm away from the anal verge. Biopsy showed severe dysplasia. Endoscopic clips were placed for marking purposes. Three additional adenomatous polyps in the right, transverse, and left colon were found and removed. Preoperative abdominal X-ray showed the presence of clips at the level of the left pelvic bone. Since colonoscopy was performed more than two weeks before surgery, intraoperative colonoscopy was used to ensure tumor location.

During the video, surgical pitfalls were highlighted, and the author showed the importance of preoperative tumor tattooing, demonstrated anatomical landmarks, and the starting point of mesenteric dissection for left colectomy at the superior mesenteric vein (IMV). Recommendations for inferior mesenteric artery (IMA) ligation, hypogastric nerve preservation, splenic flexure mobilization, stapling recommendations during colon transection, colorectal anastomosis, and means to prevent postoperative complications were provided. The value of leak test, endoscopic anastomosis evaluation, and the use of indocyanine green (ICG) were also emphasized.
Colonic perforation: laparoscopic approach
An 89-year-old man was admitted to hospital because of complaints of abdominal pain and diarrhea with a one-month evolution. His medical history included atrial fibrillation for which he was on anticoagulants, type 2 diabetes mellitus, and recurrent syncopes. The patient’s surgical history included cholecystectomy, right inguinal hernioplasty, and prostatectomy. During the performance of a colonoscopy, the patient had an onset of intense and widespread abdominal pain. Colonoscopy showed a suspicion of perforation at the level of the sigmoid colon, without any evidence of tumor-like lesions. CT-scan showed a pneumoperitoneum and perforation at the level of the distal sigmoid colon. It was decided to perform a laparoscopic approach. A perforation was identified in the rectosigmoid junction. The perforation was sutured.
The patient presented with an acute coronary syndrome in the immediate postoperative period, which was managed with medical treatment. Subsequently, the patient had symptoms of paralytic ileus, which were managed conservatively with subsequent recovery of bowel transit. The patient was discharged on postoperative day 10.
I Fraile Alonso, A Trinidad Borras, J Álvarez Martin
Surgical intervention
6 days ago
262 views
6 likes
0 comments
07:42
Colonic perforation: laparoscopic approach
An 89-year-old man was admitted to hospital because of complaints of abdominal pain and diarrhea with a one-month evolution. His medical history included atrial fibrillation for which he was on anticoagulants, type 2 diabetes mellitus, and recurrent syncopes. The patient’s surgical history included cholecystectomy, right inguinal hernioplasty, and prostatectomy. During the performance of a colonoscopy, the patient had an onset of intense and widespread abdominal pain. Colonoscopy showed a suspicion of perforation at the level of the sigmoid colon, without any evidence of tumor-like lesions. CT-scan showed a pneumoperitoneum and perforation at the level of the distal sigmoid colon. It was decided to perform a laparoscopic approach. A perforation was identified in the rectosigmoid junction. The perforation was sutured.
The patient presented with an acute coronary syndrome in the immediate postoperative period, which was managed with medical treatment. Subsequently, the patient had symptoms of paralytic ileus, which were managed conservatively with subsequent recovery of bowel transit. The patient was discharged on postoperative day 10.
Laparoscopic left hemicolectomy with manual intracorporeal anastomosis
The best surgical approach for splenic flexure tumors is not well defined yet.
The distal third of the transverse colon has an embryological origin in the hindgut, and the splenic flexure classically shows a dual lymphatic drainage, the proximal retropancreatic and the distal to the lymphatic pedicle of both the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV). Nakagoe et al. showed that the majority of positive nodes have distal lymphatic spread to the paracolic archway and up to the origin of the left colic artery. Lymph nodes of the middle colic artery and its left branch are positive in a small percentage (0 and 4.2% respectively).
As a result, a left segmental colectomy is a valid option for splenic flexure and distal transverse colon tumors because it allows vascular ligation at the root of the vessels, dissection along the embryological planes, and adequate bowel margins from the tumor. The preservation of the IMV should reduce impaired venous drainage of the sigmoid colon, which can be associated with anastomotic leakage, without compromising complete mesocolic excision.
An intracorporeal anastomosis for left colonic resection may have the same advantages as for a right hemicolectomy, but can be technically more challenging.
This video shows a laparoscopic left hemicolectomy with manual intracorporeal anastomosis and preservation of the IMV for a tumor of the distal transverse colon.
A Canaveira Manso, M Rosete, R Nemésio, M Fernandes
Surgical intervention
4 months ago
2509 views
24 likes
0 comments
16:43
Laparoscopic left hemicolectomy with manual intracorporeal anastomosis
The best surgical approach for splenic flexure tumors is not well defined yet.
The distal third of the transverse colon has an embryological origin in the hindgut, and the splenic flexure classically shows a dual lymphatic drainage, the proximal retropancreatic and the distal to the lymphatic pedicle of both the inferior mesenteric artery (IMA) and the inferior mesenteric vein (IMV). Nakagoe et al. showed that the majority of positive nodes have distal lymphatic spread to the paracolic archway and up to the origin of the left colic artery. Lymph nodes of the middle colic artery and its left branch are positive in a small percentage (0 and 4.2% respectively).
As a result, a left segmental colectomy is a valid option for splenic flexure and distal transverse colon tumors because it allows vascular ligation at the root of the vessels, dissection along the embryological planes, and adequate bowel margins from the tumor. The preservation of the IMV should reduce impaired venous drainage of the sigmoid colon, which can be associated with anastomotic leakage, without compromising complete mesocolic excision.
An intracorporeal anastomosis for left colonic resection may have the same advantages as for a right hemicolectomy, but can be technically more challenging.
This video shows a laparoscopic left hemicolectomy with manual intracorporeal anastomosis and preservation of the IMV for a tumor of the distal transverse colon.
Laparoscopic right hemicolectomy with excision of a pancreatic neuroendocrine tumor (pNET)
Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms, which account for less than 5% of all pancreatic tumors, with an incidence of 0.48 cases/100,000. They may be benign or malignant and tend to grow slower than exocrine tumors. They develop from the abnormal growth of endocrine cells in the pancreas and are either functional or nonfunctional, and may or may not cause signs or symptoms. Pancreatic NETs that have not spread outside the pancreas should be completely removed, if possible, because these tumors are more likely to be cured with surgery. This video shows a case of a pNET of the uncinate process, discovered in the study of a right colon cancer. Because of the small size of the pNET and its location, the association of a right laparoscopic hemicolectomy with a pancreatic tumor excision was deemed feasible. The mobilization of the mesenteric root allowed to identify the uncinate process and to prepare for the pNET excision. After the exposure of the duodenum and the retroperitoneal plane, the surgery continued with a right hemicolectomy and a complete mesocolic excision. An intracorporeal anastomosis was constructed and the surgical specimen was retrieved through a suprapubic incision. The pathological report revealed a T2N1 caecal adenocarcinoma and a G2 pNET.
A Canaveira Manso, M Rosete, R Nemésio, R Martins
Surgical intervention
4 months ago
753 views
7 likes
0 comments
17:16
Laparoscopic right hemicolectomy with excision of a pancreatic neuroendocrine tumor (pNET)
Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms, which account for less than 5% of all pancreatic tumors, with an incidence of 0.48 cases/100,000. They may be benign or malignant and tend to grow slower than exocrine tumors. They develop from the abnormal growth of endocrine cells in the pancreas and are either functional or nonfunctional, and may or may not cause signs or symptoms. Pancreatic NETs that have not spread outside the pancreas should be completely removed, if possible, because these tumors are more likely to be cured with surgery. This video shows a case of a pNET of the uncinate process, discovered in the study of a right colon cancer. Because of the small size of the pNET and its location, the association of a right laparoscopic hemicolectomy with a pancreatic tumor excision was deemed feasible. The mobilization of the mesenteric root allowed to identify the uncinate process and to prepare for the pNET excision. After the exposure of the duodenum and the retroperitoneal plane, the surgery continued with a right hemicolectomy and a complete mesocolic excision. An intracorporeal anastomosis was constructed and the surgical specimen was retrieved through a suprapubic incision. The pathological report revealed a T2N1 caecal adenocarcinoma and a G2 pNET.
Robotically assisted right colectomy with fluorescence-guided complete mesocolon excision
In robotic right hemicolectomy for cancer, appropriate lymphadenectomy and anastomotic leak prevention are critical. Visualization of draining lymph nodes, of primary tumor site and blood flow using the near-infrared (NIR) fluorescence da Vinci® imaging system is a recent development.
We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) fluorescence.
The day before surgery, a colonoscopy was performed and ICG was injected around the tumor in the submucosa.
Robotic right hemicolectomy was performed with suprapubic trocars layout and bottom to up dissection, with CME, central vessel ligation, and D3 lymphadenectomy.
ICG was intraoperatively administered intravenously to assess bowel perfusion before anastomosis. The identification of the primary tumor site and of bowel stumps perfusion were possible and the accuracy in identifying the D3 lymphatic basin was high, allowing for an image-guided radical lymphadenectomy. Fluorescent technology represents a valuable innovation to improve colon cancer surgery.
W Petz, E Bertani, D Ribero, D Lo Conte, A Mellano, A Piccioli, S Borin, G Spinoglio
Surgical intervention
4 months ago
706 views
3 likes
0 comments
08:43
Robotically assisted right colectomy with fluorescence-guided complete mesocolon excision
In robotic right hemicolectomy for cancer, appropriate lymphadenectomy and anastomotic leak prevention are critical. Visualization of draining lymph nodes, of primary tumor site and blood flow using the near-infrared (NIR) fluorescence da Vinci® imaging system is a recent development.
We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenectomy using Indocyanine Green (ICG) fluorescence.
The day before surgery, a colonoscopy was performed and ICG was injected around the tumor in the submucosa.
Robotic right hemicolectomy was performed with suprapubic trocars layout and bottom to up dissection, with CME, central vessel ligation, and D3 lymphadenectomy.
ICG was intraoperatively administered intravenously to assess bowel perfusion before anastomosis. The identification of the primary tumor site and of bowel stumps perfusion were possible and the accuracy in identifying the D3 lymphatic basin was high, allowing for an image-guided radical lymphadenectomy. Fluorescent technology represents a valuable innovation to improve colon cancer surgery.
Fully laparoscopic right colectomy for caecal tumor with “vessels first’ approach
Over the last few years, laparoscopic colorectal surgery has increased exponentially worldwide. When combined with an enhanced recovery program, a significant reduction in the length of hospital stay can be achieved, coupled with an early return to normal activities for the patient.
This is the case of a 68-year-old obese woman with a BMI of 30 presenting with a caecal tumor. Her major co-morbidities are chronic obstructive pulmonary disease (COPD) and high blood pressure. The patient complained of chronic abdominal pain and presented a positive fecal occult blood test. Colonoscopy showed a caecal tumor. Biopsy confirmed an adenocarcinoma. CT-scan did not show any distant metastasis. A full laparoscopic approach with a medial-to-lateral and ‘vessels first’ approach is shown.
A D'Urso, M Rodriguez, D Mutter, J Marescaux
Surgical intervention
4 months ago
2762 views
21 likes
3 comments
13:27
Fully laparoscopic right colectomy for caecal tumor with “vessels first’ approach
Over the last few years, laparoscopic colorectal surgery has increased exponentially worldwide. When combined with an enhanced recovery program, a significant reduction in the length of hospital stay can be achieved, coupled with an early return to normal activities for the patient.
This is the case of a 68-year-old obese woman with a BMI of 30 presenting with a caecal tumor. Her major co-morbidities are chronic obstructive pulmonary disease (COPD) and high blood pressure. The patient complained of chronic abdominal pain and presented a positive fecal occult blood test. Colonoscopy showed a caecal tumor. Biopsy confirmed an adenocarcinoma. CT-scan did not show any distant metastasis. A full laparoscopic approach with a medial-to-lateral and ‘vessels first’ approach is shown.
Skeletons in the cupboard: MY mistakes
Professor Heald teaches us the importance of learning from our mistakes and from other people so as not to commit them again, he emphasizes lessons to learn where he tells us not only about the challenges of pelvic, oncological surgery, and possible mistakes to be made. We advise you to feel free to say what we think in the surgery room, you can help in difficult situations and proper planning prior to all surgeries.
Beautiful lesson of the day: to fail to prepare is to prepare to fail.
In this outstanding didactic lecture, Professor Heald explains part of his great experience and the experiences of a career of more than 50 years, truly amazing! and life lessons he now shares with us, where he shows a clear example that “we must be our own sternest critics” and have the “courage to fail”.
in conclusion: beware of Panic Factor, and you can always call a friend, talk to patients, forget your own pride, learn to apologize.
Remember: there are things under your control and others that are not!
Thank you Professor Heald for these great teachings.
RJ Heald
Lecture
4 months ago
513 views
5 likes
1 comment
31:37
Skeletons in the cupboard: MY mistakes
Professor Heald teaches us the importance of learning from our mistakes and from other people so as not to commit them again, he emphasizes lessons to learn where he tells us not only about the challenges of pelvic, oncological surgery, and possible mistakes to be made. We advise you to feel free to say what we think in the surgery room, you can help in difficult situations and proper planning prior to all surgeries.
Beautiful lesson of the day: to fail to prepare is to prepare to fail.
In this outstanding didactic lecture, Professor Heald explains part of his great experience and the experiences of a career of more than 50 years, truly amazing! and life lessons he now shares with us, where he shows a clear example that “we must be our own sternest critics” and have the “courage to fail”.
in conclusion: beware of Panic Factor, and you can always call a friend, talk to patients, forget your own pride, learn to apologize.
Remember: there are things under your control and others that are not!
Thank you Professor Heald for these great teachings.
Transverse colectomy with total mesocolic excision for cancer - Safe Transverse
In this key lecture, Dr. Armando Melani explains how transverse colectomy with total mesocolic excision for cancer is a doable and safe surgery, in his opinion and according to his experience.
Dr. Melani outlines the recommendations for a safe transverse colectomy and teaches us how to avoid lesions in the superior mesenteric vessels, shows laparoscopic mobilization for resection of the transverse colon due to cancer, and demonstrates an excellent vascular approach.
Finally, Dr. Melani provides the rationale of the extension of the LND for right colon cancer and gives a didactic demonstration in this video.
In conclusion, transverse colectomy with total mesocolic excision for cancer is relatively difficult. The reasons for this are the anatomical variations of middle colic vessels, transverse mesocolon attachments with the pancreatic head, and venous communications. In this authoritative lecture, Dr. Melani demonstrates the laparoscopic approach and provides all recommendations to achieve a successful surgery.
A Melani
Lecture
4 months ago
696 views
1 like
0 comments
09:46
Transverse colectomy with total mesocolic excision for cancer - Safe Transverse
In this key lecture, Dr. Armando Melani explains how transverse colectomy with total mesocolic excision for cancer is a doable and safe surgery, in his opinion and according to his experience.
Dr. Melani outlines the recommendations for a safe transverse colectomy and teaches us how to avoid lesions in the superior mesenteric vessels, shows laparoscopic mobilization for resection of the transverse colon due to cancer, and demonstrates an excellent vascular approach.
Finally, Dr. Melani provides the rationale of the extension of the LND for right colon cancer and gives a didactic demonstration in this video.
In conclusion, transverse colectomy with total mesocolic excision for cancer is relatively difficult. The reasons for this are the anatomical variations of middle colic vessels, transverse mesocolon attachments with the pancreatic head, and venous communications. In this authoritative lecture, Dr. Melani demonstrates the laparoscopic approach and provides all recommendations to achieve a successful surgery.
A standardized approach for complete mesocolic excision (CME) for right colon cancer
In this key lecture, Dr. Antonello Forgione presents a clear and precise description of the most important anatomical points as well as the surgical technique for complete mesocolic excision (CME) during a right laparoscopic colectomy, in cases of cancer.
As described in the video, four ports are used, all located on the left flank. A caudocranial dissection of the mesocolon is performed along the superior mesenteric vein to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, right and middle colic vessels in their origins. The gastrocolic trunk is completely dissected and the upper right colic vein is cut and divided. The transverse colon and the terminal ileum are divided, the colon is mobilized, and the ileo-transverse intracorporeal stapled anastomosis is fashioned.
Laparoscopic CME is feasible and very useful. However, it is necessary to have an extensive knowledge of the vascular anatomy of the right colon, as well as an experience in advanced laparoscopic techniques to obtain the expected outcomes.
Finally, Dr. Forgione provides recommendations to perform the surgery in obese patients.
A Forgione
Lecture
4 months ago
512 views
4 likes
0 comments
14:20
A standardized approach for complete mesocolic excision (CME) for right colon cancer
In this key lecture, Dr. Antonello Forgione presents a clear and precise description of the most important anatomical points as well as the surgical technique for complete mesocolic excision (CME) during a right laparoscopic colectomy, in cases of cancer.
As described in the video, four ports are used, all located on the left flank. A caudocranial dissection of the mesocolon is performed along the superior mesenteric vein to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, right and middle colic vessels in their origins. The gastrocolic trunk is completely dissected and the upper right colic vein is cut and divided. The transverse colon and the terminal ileum are divided, the colon is mobilized, and the ileo-transverse intracorporeal stapled anastomosis is fashioned.
Laparoscopic CME is feasible and very useful. However, it is necessary to have an extensive knowledge of the vascular anatomy of the right colon, as well as an experience in advanced laparoscopic techniques to obtain the expected outcomes.
Finally, Dr. Forgione provides recommendations to perform the surgery in obese patients.
Vascular anatomy of left and right colon: standard vs. variations
The vascular anatomy of the colon has some anatomical variations [1]. In this video, starting from the normal surgical anatomy of the colon, authors show many vascular anomalies of surgical interest, which should be known in order to avoid intraoperative complications. In the right colon, the ileocolic artery and the middle colic artery are constantly present in all patients as they arise from the superior mesenteric vessels [2]. Right colic vessels are present only in 80% of cases. The position of ileocolic vessels related to the superior mesenteric vein (SMV) is a key landmark. In this video, starting from the normal surgical anatomy of the right colon, authors show variant ileocolic vessels position defined type A pattern, with ileocolic artery (ICA) which lies in the anterior position in respect to the ileocolic vein (ICV). Authors also show an anomalous origin of the ileocolic vessels, which are more upper in respect to their standard position. Commonly, the ileocolic artery (ICA) lies posterior to the SMV (83%, type B). However, the ICA sometimes lies anteriorly to the SMV (17%, type A) [1]. The vascular system of the left colon has fewer variations in terms of position and origin, contrarily to the right colon. The most frequent variations of the inferior mesenteric artery (IMA) supply involve the division of the sigmoid arteries, as classified by Latarjet in two different types, depending on the anatomical relationship between the left colic and sigmoid arteries [3]. However, in this video authors show a rare case of IMA arising from the superior mesenteric artery [4].
References:
1. Milsom JW, Böhm B, Nakajima K. Laparoscopic Colorectal Surgery 2006, Springer.
2. Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019;17:16.
3. Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2016;38:477-84.
4. Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a Korean woman. J Korean Med Sci 2011;26:1382-5.
F Corcione, E Pontecorvi, V Silvestri, G Merola, U Bracale
Surgical intervention
4 months ago
2242 views
22 likes
0 comments
21:44
Vascular anatomy of left and right colon: standard vs. variations
The vascular anatomy of the colon has some anatomical variations [1]. In this video, starting from the normal surgical anatomy of the colon, authors show many vascular anomalies of surgical interest, which should be known in order to avoid intraoperative complications. In the right colon, the ileocolic artery and the middle colic artery are constantly present in all patients as they arise from the superior mesenteric vessels [2]. Right colic vessels are present only in 80% of cases. The position of ileocolic vessels related to the superior mesenteric vein (SMV) is a key landmark. In this video, starting from the normal surgical anatomy of the right colon, authors show variant ileocolic vessels position defined type A pattern, with ileocolic artery (ICA) which lies in the anterior position in respect to the ileocolic vein (ICV). Authors also show an anomalous origin of the ileocolic vessels, which are more upper in respect to their standard position. Commonly, the ileocolic artery (ICA) lies posterior to the SMV (83%, type B). However, the ICA sometimes lies anteriorly to the SMV (17%, type A) [1]. The vascular system of the left colon has fewer variations in terms of position and origin, contrarily to the right colon. The most frequent variations of the inferior mesenteric artery (IMA) supply involve the division of the sigmoid arteries, as classified by Latarjet in two different types, depending on the anatomical relationship between the left colic and sigmoid arteries [3]. However, in this video authors show a rare case of IMA arising from the superior mesenteric artery [4].
References:
1. Milsom JW, Böhm B, Nakajima K. Laparoscopic Colorectal Surgery 2006, Springer.
2. Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019;17:16.
3. Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2016;38:477-84.
4. Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a Korean woman. J Korean Med Sci 2011;26:1382-5.
Redo laparoscopic anterior resection
The reported incidence rates of regional recurrence for colorectal cancer after oncologic resection ranged between 5% and 19%. Locoregional recurrence occurs in the anastomotic site, the remnant colon, the peritoneal surface (nodal or soft tissue), or the retroperitoneum. As reported in the literature, in colorectal cancers, mucinous differentiation, lymphovascular invasion and anastomotic leakage are independent risk factors for anastomotic recurrence.
We present the case of an 86 year-old female patient. In 2014, the patient underwent a laparoscopic left colectomy for a Haggitt level 4 sigmoid polyp. The definitive histologic features showed a T2N0M0 mucinous adenocarcinoma. During the postoperative follow-up, 46 months after the left colectomy, an anastomotic recurrence was found. The patient underwent a laparoscopic colorectal resection for anastomotic recurrence. The operative time was 220 minutes. The patient was discharged on postoperative day 6. No complications occurred intraoperatively and postoperatively.
References:
1. Gopalan S, Bose JC, Periasamy S (2015) Anastomotic Recurrence of Colon Cancer-is it a Local Recurrence, a Second Primary, or a Metastatic Disease (Local Manifestation of Systemic Disease)? Indian J Surg 77:232-236.
2. Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter L, Crolla R, Schreinemakers JMJ (2018) Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol 27:730-736.
3. Jung WB, Yu CS, Lim SB, Park IJ, Yoon YS, Kim JC (2017) Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 41:285-294.
F Corcione, M D'Ambra, U Bracale, S Dilillo, G Luglio
Surgical intervention
8 months ago
3157 views
4 likes
1 comment
23:20
Redo laparoscopic anterior resection
The reported incidence rates of regional recurrence for colorectal cancer after oncologic resection ranged between 5% and 19%. Locoregional recurrence occurs in the anastomotic site, the remnant colon, the peritoneal surface (nodal or soft tissue), or the retroperitoneum. As reported in the literature, in colorectal cancers, mucinous differentiation, lymphovascular invasion and anastomotic leakage are independent risk factors for anastomotic recurrence.
We present the case of an 86 year-old female patient. In 2014, the patient underwent a laparoscopic left colectomy for a Haggitt level 4 sigmoid polyp. The definitive histologic features showed a T2N0M0 mucinous adenocarcinoma. During the postoperative follow-up, 46 months after the left colectomy, an anastomotic recurrence was found. The patient underwent a laparoscopic colorectal resection for anastomotic recurrence. The operative time was 220 minutes. The patient was discharged on postoperative day 6. No complications occurred intraoperatively and postoperatively.
References:
1. Gopalan S, Bose JC, Periasamy S (2015) Anastomotic Recurrence of Colon Cancer-is it a Local Recurrence, a Second Primary, or a Metastatic Disease (Local Manifestation of Systemic Disease)? Indian J Surg 77:232-236.
2. Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter L, Crolla R, Schreinemakers JMJ (2018) Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol 27:730-736.
3. Jung WB, Yu CS, Lim SB, Park IJ, Yoon YS, Kim JC (2017) Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 41:285-294.
Laparoscopic complete mesocolic excision (CME) for right colon cancer
The aim of the video is to describe the anatomical landmarks and the surgical technique for complete mesocolic excision during a laparoscopic right colectomy for cancer.
Preoperative high-resolution CT-scan and 3D printed models of the patient’s vascular anatomy is obtained to study the peculiar vessels distribution. Four ports are used, all located in the left flank as described in the video. Dissection between the visceral fascia which covers the posterior layer of the mesocolon and the parietal fascia covering the retroperitoneum (Toldt’s fascia) is carried out by means of monopolar electrocautery and combined advanced bipolar and ultrasonic dissection device. Caudocranial dissection of the mesocolon along the route of the superior mesenteric vein is performed, up to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, the right and middle colic vessels at their origins. The gastrocolic trunk is fully dissected and the superior right colic vein clipped and divided. The transverse colon and terminal ileum are divided, the colon is mobilized and ileo-transverse intracorporeal stapled anastomosis is fashioned.
Between April 2017 and December 2018, 46 laparoscopic right hemicolectomies with CME were performed. There were no major vascular lesions. All intraoperative bleedings in the peripancreatic area were controlled with bipolar instruments and hemostatic devices, and there was no need for intraoperative blood cell transfusions.
Laparoscopic CME is feasible, but extensive knowledge of the vascular anatomy of the right colon as well as experience in advanced laparoscopic technique is required.
S Macina, L Baldari, E Cassinotti, M Ballabio, A Spota, M de Francesco, L Boni
Surgical intervention
11 months ago
5148 views
25 likes
1 comment
07:10
Laparoscopic complete mesocolic excision (CME) for right colon cancer
The aim of the video is to describe the anatomical landmarks and the surgical technique for complete mesocolic excision during a laparoscopic right colectomy for cancer.
Preoperative high-resolution CT-scan and 3D printed models of the patient’s vascular anatomy is obtained to study the peculiar vessels distribution. Four ports are used, all located in the left flank as described in the video. Dissection between the visceral fascia which covers the posterior layer of the mesocolon and the parietal fascia covering the retroperitoneum (Toldt’s fascia) is carried out by means of monopolar electrocautery and combined advanced bipolar and ultrasonic dissection device. Caudocranial dissection of the mesocolon along the route of the superior mesenteric vein is performed, up to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, the right and middle colic vessels at their origins. The gastrocolic trunk is fully dissected and the superior right colic vein clipped and divided. The transverse colon and terminal ileum are divided, the colon is mobilized and ileo-transverse intracorporeal stapled anastomosis is fashioned.
Between April 2017 and December 2018, 46 laparoscopic right hemicolectomies with CME were performed. There were no major vascular lesions. All intraoperative bleedings in the peripancreatic area were controlled with bipolar instruments and hemostatic devices, and there was no need for intraoperative blood cell transfusions.
Laparoscopic CME is feasible, but extensive knowledge of the vascular anatomy of the right colon as well as experience in advanced laparoscopic technique is required.
Laparoscopic right colectomy for caecal cancer with prophylactic lighted ureteral stenting (LUS)
Identifying the ureter during colorectal surgery (CRS) is one of the most critical steps of the operation. Iatrogenic ureteral injury occurs very rarely, with an incidence ranging from 0.28 to 7.6%. However, this complication has the potential to be devastating and its prevention is a priority. Laparoscopic approach in CRS reduces the tactile feedback of the surgeon who has to rely only on visual identification to prevent iatrogenic injury. As a result, lighted ureteral stents (LUS) were devised to improve visual identification of ureters throughout the dissection.
This video presents the case of a 70-year-old woman presenting with a caecal adenocarcinoma. She underwent a laparoscopic right colectomy with intracorporeal anastomosis. A LUS (IRIS U-kit®, Stryker) was placed under general anesthesia, just before the beginning of the surgical procedure, requiring about 15 minutes to be accomplished. The stent was removed after the operation, before the end of anesthesia, with no postoperative sequelas.
In order to prevent any potential iatrogenic injury, the selective or routine use of LUS during laparoscopic CRS could well improve the identification of the ureter, with a negligible increase in the operative time.
E Soricelli, E Facchiano, L Leuratti, G Quartararo, N Console, P Tonelli, M Lucchese
Surgical intervention
11 months ago
4096 views
15 likes
0 comments
09:10
Laparoscopic right colectomy for caecal cancer with prophylactic lighted ureteral stenting (LUS)
Identifying the ureter during colorectal surgery (CRS) is one of the most critical steps of the operation. Iatrogenic ureteral injury occurs very rarely, with an incidence ranging from 0.28 to 7.6%. However, this complication has the potential to be devastating and its prevention is a priority. Laparoscopic approach in CRS reduces the tactile feedback of the surgeon who has to rely only on visual identification to prevent iatrogenic injury. As a result, lighted ureteral stents (LUS) were devised to improve visual identification of ureters throughout the dissection.
This video presents the case of a 70-year-old woman presenting with a caecal adenocarcinoma. She underwent a laparoscopic right colectomy with intracorporeal anastomosis. A LUS (IRIS U-kit®, Stryker) was placed under general anesthesia, just before the beginning of the surgical procedure, requiring about 15 minutes to be accomplished. The stent was removed after the operation, before the end of anesthesia, with no postoperative sequelas.
In order to prevent any potential iatrogenic injury, the selective or routine use of LUS during laparoscopic CRS could well improve the identification of the ureter, with a negligible increase in the operative time.
Endoscopic full-thickness colonic resection for malignant polyp excision
This is the case of an 83-year-old woman who presented with per rectal bleeding. She had flexible sigmoidoscopy, which showed a 1.5 to 2cm flat polyp with central depression and non-lifting sign. CT-scan of the chest, abdomen, and pelvis was performed and showed no metastasis. The case was discussed with the multidisciplinary team and decision was made to perform an endoscopic full-thickness colonic resection. The case was performed using the colonic FTRD® set (OVESCO™). The procedure was completed successfully and the patient was discharged on postoperative day 1. During the postoperative follow-up, the resection margin was clear. This is the first case performed in the North-East of England to our knowledge. Since this case, we have performed another case.
Y Aawsaj, K Khan, M Hayat
Surgical intervention
11 months ago
824 views
2 likes
1 comment
05:30
Endoscopic full-thickness colonic resection for malignant polyp excision
This is the case of an 83-year-old woman who presented with per rectal bleeding. She had flexible sigmoidoscopy, which showed a 1.5 to 2cm flat polyp with central depression and non-lifting sign. CT-scan of the chest, abdomen, and pelvis was performed and showed no metastasis. The case was discussed with the multidisciplinary team and decision was made to perform an endoscopic full-thickness colonic resection. The case was performed using the colonic FTRD® set (OVESCO™). The procedure was completed successfully and the patient was discharged on postoperative day 1. During the postoperative follow-up, the resection margin was clear. This is the first case performed in the North-East of England to our knowledge. Since this case, we have performed another case.