Laparoscopy reduces iatrogenic splenic injuries during colorectal surgery

Işık, Özgen; Sapcı, İpek; Aytaç, Erman; Snyder, Karen E.; Stocchi, Luca; Keßler, Hermann; Steele, Scott R.; Görgün, Emre

doi:10.1007/s10151-018-1861-7

Cited by 12 publications

(8 citation statements)

References 15 publications

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“…Fig. 1 Completeness of total mesorectal excision procedures represents the most important reason for iatrogenic injury, better and magnified visualization of the spleen and its attachments provided by the laparoscopic approach helps the surgeon avoid unnecessary traction [49]. RS provides similar advantages in terms of improved anatomic visualization leading to controlled traction.…”

Section: Technical Considerations Of Splenic Flexure Mobilizationmentioning

confidence: 99%

Robotic surgery for rectal cancer as a platform to build on: review of current evidence

2020

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Laparoscopy in colorectal surgery reduces the rate of postoperative complications, shortens the length of stay in hospital, and improves the quality of patient care. Despite these established benefits, the technical challenges of rectal resection for cancer have resulted in most operations being performed through open surgery in the USA. Moreover, controversy in the current literature questions the oncologic safety of a laparoscopic approach for rectal cancer. How then can surgeons innovate to overcome the technical challenges while preserving the critical oncological outcomes of high-quality rectal cancer surgery? Robotics may be a platform that allows us to overcome the technical challenges in the pelvis while maintaining both oncological outcomes and the benefits of a minimally invasive technique. Current evidence suggests that the quality of total mesorectal excision, the rates of circumferential margin involvement, and postoperative outcomes are comparable between robotic and laparoscopic surgery. While a robotic approach demonstrates lower conversion rates and reduced surgeon workload, the operative time is longer and initial costs are higher; however, time and future science will determine its true benefits. We review the current state of robotic surgery and its impact on rectal cancer surgery.

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Section: Technical Considerations Of Splenic Flexure Mobilizationmentioning

confidence: 99%

Robotic surgery for rectal cancer as a platform to build on: review of current evidence

2020

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“…Splenic injury during colon surgery fortunately is rare and occurred in 1.1% of over 2,300 colorectal resections in a recent single institutional study. 27 Splenic salvage (topical agents 64% and splenorrhaphy 16%) was achieved in the vast majority of cases while splenectomy was necessary in 20%. Interestingly, laparoscopic compared with open technique was associated with decreased incidence of splenic injury likely due to improved visualization of the left upper quadrant.…”

Section: Splenic Flexure Mobilizationmentioning

confidence: 99%

“…28 Interestingly, splenic injury is not necessarily limited to SFM and increased rates occur following any prior abdominal surgery. 27 Awareness of the mechanisms of injury compels precise dissection of the embryologic attachments or lienocolic and phrenicocolic ligaments and, in particular, judicious tension on the bowel and omentum in the vicinity of the spleen. 28 The matter regarding actual mesenteric release mediallyor the level of vessel division (arterial and venous)is a particularly relevant aspect of this maneuver.…”

Section: Splenic Flexure Mobilizationmentioning

confidence: 99%

Gaining Mesenteric Length following Colorectal Resection: Essential Maneuvers to Avoid Anastomotic Tension

Vargas

2023

Clin Colon Rectal Surg

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A surgeon must possess the knowledge and technical skill to obtain length following a left-sided colorectal resection to perform a tension free anastomosis. The distal target organ – either rectum or anus – is fixed in location, and therefore requires surgeons to acquire mastery of proximal mobilization of the colonic conduit. Generally, splenic flexure mobilization (SFM) provides adequate length. Surgeons benefit from clearer understanding of the multiple steps involved in SFM as a result of improved visualization and demonstration of the relevant anatomy – adjacent organs and the attachments, embryologic planes, and mesenteric structures. Much may be attributed to laparoscopic and robotic platforms which provided improved exposure and as a result, development or refinement of novel approaches for SFM with potential advantages. Complete mobilization draws upon the sum or combination of the varied approaches to accomplish the goal. However, in the situation where extended resection is necessary or in the case of re-operative surgery sacrificing either more proximal or distal large intestine often occurs, the transverse colon or even the ascending colon represents the proximal conduit for anastomosis. This challenging situation requires familiarity with special maneuvers to achieve colorectal or coloanal anastomosis using these more proximal conduits. In such instances, operative techniques such as either ileal mesenteric window with retroileal anastomosis or de-rotation of the right colon (Deloyer's procedure) enable the intestinal surgeon to construct such anastomoses and thereby avoid stoma creation or loss of additional large intestine.

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“…Although the use of laparoscopy has been reported to reduce iatrogenic splenic injury during mobilization of the splenic flexure 4 , 6 , this has not been confirmed by others who have reported a higher incidence of splenic flexure mobilization-related complications in laparoscopic surgery than in open procedures 7 . Thus, mobilizing the splenic flexure remains challenging, even in the era of laparoscopic colorectal resection.…”

Section: Introductionmentioning

confidence: 97%

Classification of the colonic splenic flexure based on three-dimensional CT analysis

et al. 2021

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Background Mobilization of the splenic flexure can be a challenging surgical step in colorectal surgery. This study aimed to classify the splenic flexure based on the three-dimensional (3D) coordinates of the splenic hilum and left renal hilum. This classification was used to compare splenic flexure mobilization during colorectal resection. Methods CT images of patients with colorectal cancer treated between April 2018 and December 2019 were analysed retrospectively. 3D mutual positioning of the splenic flexure from the ligament of Treitz to the splenic hilum or the left renal hilum was used to classify patients into three groups using cluster analysis. The difference in the procedure time between groups was also analysed in a subset of patients undergoing laparoscopic colectomy with complete splenic flexure mobilization. Results Of 515 patients reviewed, 319 with colorectal cancers were included in the study and categorized based on the 3D coordinates of the splenic hilum and left renal hilum as caudal (100 patients), cranial (118) and lateral (101) positions. Male sex (P < 0.001), older age (P = 0.004) and increased bodyweight (P = 0.043) were independent characteristics of the lateral group in multiple logistic regression analysis. Thirty-four patients underwent complete splenic flexure mobilization during the study period; this took significantly longer (mean 78.7 min) in the lateral group than in the caudal and cranial groups (41.8 and 43.2 min respectively; P = 0.006). Conclusion Locating the splenic flexure using 3D coordinates could be helpful in predicting a longer duration for mobilization of the splenic flexure.

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Laparoscopy reduces iatrogenic splenic injuries during colorectal surgery

Cited by 12 publications

References 15 publications

Robotic surgery for rectal cancer as a platform to build on: review of current evidence

Robotic surgery for rectal cancer as a platform to build on: review of current evidence

Gaining Mesenteric Length following Colorectal Resection: Essential Maneuvers to Avoid Anastomotic Tension

Classification of the colonic splenic flexure based on three-dimensional CT analysis

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