Laparoscopos colorectalis resectiók – 393 eset tapasztalatai

Abstract

Laparoscopic (LAP) colorectal surgery has become increasingly popular worldwide. Large comparative studies demonstrate the benefit of the method, but data about routine application are relatively moderate. This study presents the results of laparoscopic colorectal linterventions in a non-selected patient population, who were admitted to the 1st Department of Surgery, Semmelweis University between January 2004 and December 2011. 393 patients underwent LAP surgery. In 333 cases the malignant tumor indicated surgery. T3 tumor rate was 62.7%. Synchronous liver metastases were detected in 17 cases, three of them were single and operable, but 14 cases were multiplex and inoperable. Bowel was successfully resected in all cases. Complication rate was 9.9 percent. In-hospital mortality was 2.0%. Length of hospital stay of non-complicated cases was 6.7 days. In 9 cases single incision intervention was performed, with an average length of hospital stay of four days. Rate of sphincter preserving rectal resections were 87.2%. 59 (15.0%) patients underwent conversion from LAP to open surgery. Operating time decreased by time, but both OP time and conversion rate were tipically determinded by the surgeon's skill. LAP surgery was found to be useful for all kind colorectal diseases requiring elective resection. Application of LAP method requires organized training programs.

A Study of 101 Laparoscopic Colorectal Surgeries: a Single Surgeon Experience. How Important Is the Learning Curve?

“…One criticism for some initial studies was the high conversion rates, e.g., 21 % in the COST study. This may indicate that some surgeons in these studies have not yet [5,8,11,12]. Owing to the magnification provided by the laparoscope, the overall surgery improves in fineness and accuracy, allowing better dissection, reducing tissue handling, retraction, and trauma, and helping preserve nerves, ureter and bladder, etc.…”

“…Kupcsulik P et al reported that length of hospital stay for non-complicated cases was 6.7 days with complication rate of 9.9 % and noted that laparoscopic surgery was found to be useful for all kind colorectal diseases requiring elective resection [12]. COLOR II and Ivanov P et al also reported reduced hospital stay with faster recovery in laparoscopically operated patients [5,11].…”

Koloproktológia régen és ma a Semmelweis Egyetem I. sz. Sebészeti Klinikáján

“…Dr. Kupcsulik Péter nagy hangsúlyt helyezett a laparoszkópos vastagbélsebészet általánossá tételére, és nagyszámú műtétről számolt be különböző hazai és nemzetközi fórumokon. 8 Párizsi és strasbourgi tanulmányútjainkat, majd a feltételek megteremtését követően indult útjára e módszer. Ezzel egyidejűleg vált rutinná a teljes mezorektum kiirtása is.…”