Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations

Abstract

The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients' characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.

Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer

“…[11] Intracorporeal anastomosis has been shown to reduce wound-related complications, facilitate early restoration of bowel function, and improve cosmesis. [12,13] However, definitive evidence on the effect of the type of anastomosis on short-term outcomes of right hemicolectomy, especially with respect to anastomotic leaks and short-term morbidity, is still awaited. [14–17] …”

Laparoscopic colorectal surgery outcomes in our first 65 case comparing with literature

“…Laparoscopy has become a good alternative to open surgery in colorectal surgery, as in many areas of the surgery [6]. Although Laparoscopy compared to open surgery has many advantages over in colorectal surgery, complications rates are reported ranging from 1.5 to 36% in different articles [7,8].…”

Comparison of short-term therapeutic effects between laparoscopic surgery and laparotomy combined with new adjuvant radiochemotherapy in progressive stage-rectal carcinoma

“…It can reduce local recurrence and clinical stages and increase excision effect. The application of radiochemotherapy of rectal carcinoma in the progressive stage has been extensively reported [7]. Although this therapy can cause a series of acute untoward effects (e.g., gastrointestinal tract infection and myelosuppression) in a short period, the total tolerance after a certain period is relatively ideal and operation is feasible [8].…”