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Laparoscopic colorectal surgery PowerPoint Presentation

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Description : Check out this medical presentation on Colon and Rectal Surgery, which is titled "Laparoscopic colorectal surgery", to know about laparoscopic colorectal surgery.

Tags : Colon, Rectal Surgery, Laparoscopic colorectal surgery

Published on : Jul 20, 2021 | Views : 3010 | Downloads : 5

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Slide 1-

Laparoscopic colorectal surgery M. Iqbal Rivai, MD DIGESTIVE SURGEON Digestive division, Department of Surgery Faculty of Medicine Andalas University General Hospital of Dr. M. Djamil Padang, Indonesia
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Indonesia Incidence of colorectal cancer in indonesia is 12.8 for 100.000 adult population with mortality of 9.5% of all cases of cancer. The third most common cancer in Indonesia (1,8/100.000)( Ministery of Health, 2006) and the second most common death was caused by cancer Colorectal Malignancy The third most common cancer in worldwide with over 1,4 million new cases in 2012
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In principle, the same operation is being performed in open or laparoscopic abdominal surgery All operations are performed under general anaesthesia
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Laparoscopy: Colorectal Cancer Levels of evidence* *Can Med Assoc, 1979
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Operations performed laparoscopically
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Can all bowel operations be performed laparoscopically It will be the decision of digestive surgeon as to whether the operation may be performed laparoscopically
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Advantages Smaller wounds Less pain Faster recovery Disadvantages Port site recurrence Oncological margins Cost Longer operation Learning curve
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Benefits for surgeon
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Bowel Function Recovery The evidence that laparoscopy offers faster bowel function recovery than the traditional open approach may be considered high
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Laparoscopy: Quality of life 225 patients 117 Laparoscopy , 108 Open Pain, hospital stay Quality of life (2 days, 2 weeks, 2 months) Symptom distress scale Quality of life index Global rating scale (1-100)
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Results M.Djamil Hospital and Siti RahmahIslamic Hospital January 2015 – Desember 2016
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Results
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Laparoscopy: Colorectal Cancer The superiority of laparoscopy in reducing pain during the same length of the postoperative period seems evident (Level I) Other aspects of quality of life warrant further investigation
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Laparoscopy: Colorectal CancerHospital stay There is high evidence (Level I) that  laparoscopy for malignancy is associated with an earlier discharge compared to laparotomy
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Laparoscopy: Colorectal CancerRecurrence
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Laparoscopy: Colorectal Cancer Survival
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Laparoscopic Colectomy Significantly longer operative times Possibly more expensive Possibly worse short term immune effects
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Laparoscopic Colectomy “Laparoscopic resection of colorectal malignancy was more expensive and time-consuming” “ The new procedure’s advantages revolve around early recovery from surgery and reduced pain”
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Laparoscopic Colectomy : Advantages vs Open Colectomy Improved cosmesis (no data but appears uncontentious) Quicker hospital discharge Less narcotic use, though possibly larger benefits for certain types of colectomy (low colonic) Possibly less pain at rest, at least for patients who have uncovered procedures Possibly earlier return of bowel function and resumption of normal diet
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Aplication of Minimally Invasive Surgery Short term benefits : Bowel function recovery Quality of life (including pain) Hospital stay Long term benefits : Recurrence Survival
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procedure
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Visualization of right colon  reflecting tAke omentum over the transverse colon
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Isolation of ileocolic pedicle Lifts the mesentry at the ileocecal junction IDENTIFYING THE DISTAL ILEOCOLIC PEDICLE WHICH IS HANDED TO THE ASISSTANT AND RETRACTED ANTERIORLY, INFERIORLY, AND LATERALLY
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The peritoneum is opened lateral to pedicle as well and ileocolic isolated completely near its base Open the peritoneum posterior to the ileocolic & parallel to the superior mesentric vessels
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Mobilization of the ascending colon & hepatic flexure Divided ileocolic pedicle is grasped and retracted anteriorly Preserving retroperitoneal fascia overlying the kidney & ureter Mesocolon is dissected Continus up behind the hepatic flexure and down behind the cecum
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Retracting the colon inferiorly  the hepaticocolic ligament is divided Medial to lateral approach along the line of toldt straightforward Heading inferiorly along the ascending colon white line of Toldt  the fusion of colic mesentery with the posterior peritoneum
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mobilization of small bowel mesentery from the retroperitoneum Cecum is retracted cephalad and anteriorly The remaining small bowel mesenteric attachment and any lateral attachment of colon are divided Ureter  identified  coursing over the iliac vessels at the pelvic inlet Right colon should be fully mobilized from retroperitoneum and can be moved into the left abdomen  expose the complete retroperitoneum and c-loop duodenum
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Division of right branch of the middle colic Right branch is isolated  divided  facilitates this transection Transection of the right branch of the middle colic  colon is now completely mobilized and entire retroperitoneum is seen with duodenum fully exposed
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Left hemicolectomy
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THANK YOU