Propensity score–matched comparison between totally laparoscopic right hemicolectomy with transcolonic natural orifice specimen extraction and conventional laparoscopic surgery with mini-laparotomy in the treatment of ascending colon cancer (with video)

Kong, Fan‐Biao; Deng, Qiao‐Ming; Deng, Hong‐Qiang; Li, Lei; Dong, Chen‐Cheng; He, Chao; Mai, Weiyi; Wang, Xiaotong; Xu, Sheng; Pang, Li-Ming

doi:10.1016/j.gie.2021.03.028

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…The incidence of incisional hernia in midline incisions is higher than that in off-midline incisions ( 21 , 22 ), so surgeons can choose smaller and off-midline incisions in SPLT-TLRH to reduce the incidence of incisional hernia in TLRH. In addition, total laparoscopic surgery can remove the specimen through a natural cavity, such as the female vagina ( 4 ), which echoes the current concept of enhanced recovery after surgery (ERAS).…”

Section: Discussionmentioning

confidence: 91%

“…Since then, it has been favored by many gastrointestinal surgeons because of faster recovery, less trauma, and better short-term outcomes than open colectomy ( 2 , 3 ). However, with the help of increasingly advanced anastomotic techniques and staplers, surgeons are no longer satisfied with laparoscopy-assisted colectomy, and total laparoscopic colectomy is being developed ( 4 ) to further minimize surgical trauma. Although the difficulty of performing intracorporeal anastomosis (IA) for total laparoscopic right hemicolectomy (TLRH) has reduced, the procedure remains challenging for some surgeons, thus hindering the wide use of TLRH in clinical practice ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and safety of self-pulling and latter transection reconstruction in totally laparoscopic right hemicolectomy

Yang,

He,

Tang

et al. 2024

Front. Oncol.

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BackgroundLaparoscopic right hemicolectomy is a standard treatment modality for right colon cancer. However, performing intracorporeal anastomosis (IA) for totally laparoscopic right hemicolectomy (TLRH) remains a challenge for some surgeons. To simplify IA in TLRH we used self-pulling and latter transection (SPLT) reconstruction in TLRH, and compared this procedure with overlap IA and laparoscopy-assisted right hemicolectomy (LARH) in order to evaluate its safety and effectiveness.MethodsPatients with right colon cancer who underwent SPLT-TLRH, TLRH with overlap IA or LARH between July 2019 and June 2023 were evaluated retrospectively. Basic information, oncological features, perioperative outcomes, and postoperative complications were compared between groups.ResultsIn total, 188 patients with right colon cancer that underwent SPLT-TLRH (n = 60), TLRH(n=21) or LARH (n = 107) were included in the study. No patient required conversion to open surgery. The operation time in SPLT-TLRH group was significantly shorter than that in TLRH group (P<0.05). Compared with LARH group, SPLT-TLRH group had significantly longer distal margins, shorter skin incisions (P < 0.001), time to first flatus, time to first defecation, and postoperative hospital stays (P<0.05).ConclusionWe introduced SPLT to TLRH. The SPLT-TLRH group demonstrated better short-term outcomes. Therefore, we believe that SPLT reconstruction is effective and safe in TLRH for right colon cancer, and can simplify reconstruction.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of self-pulling and latter transection reconstruction in totally laparoscopic right hemicolectomy

Yang,

He,

Tang

et al. 2024

Front. Oncol.

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“…We reviewed the available literature focusing on the employment of mini-invasive methods in emergency abdominal surgery and found that 1) the vast majority of studies reported on the use of laparoscopic and actively implementing robotic techniques [8-10], 2) most of the works are restricted by appendicectomy, cholecystectomy and colon surgery with associated conditions [4,11,12], 3) reports on laparoscopy in abdominal trauma are scarce and divided on its diagnostic and therapeutic potential [13,14], and 4) those studies assessed the safety and e cacy of different explorative techniques reported comparable outcomes after laparoscopic methods and mini-laparotomy [15][16][17]. As such, the role of laparotomy remains cardinal in emergency surgery, and the application of different mini-invasive techniques in acute care is to be further explored.…”

Section: Introductionmentioning

confidence: 99%

Mini-laparotomy in emergency general surgery in a second-level hospital in Zambia: a prospective cohort study

Karachentsev

Kadochi

2023

Preprint

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Background Being an integral part of the Enhanced Recovery After Surgery methodology, the mini-invasive surgical technique is an important factor in attenuating surgical stress and minimising the risk of postoperative complications. Here we present our experience of utilising the mini-laparotomy (ML) approach in emergency surgery.Methods This prospective clinical study included adult patients operated on for acute abdominal conditions at a second-level hospital in Zambia. Thirty-four patients were explored through ML, and another 34 participants had a standard laparotomy (SL) incision. The size of ML ranged from 6 to 12 cm, with the median being 10.5 cm. ML was not attempted in abdominal malignancy, generalised peritonitis, and as an approach for the relaparotomy procedures. Length of hospital of stay (LOS) and morbidity/mortality were primary endpoints. Secondary outcomes of interest included operating time (OT) and post-operative pain control. Continuous variables were presented as mean with standard deviation or median with ranges; categorical data were given as proportions and percentages. Associations between data were estimated using the t-test and chi-square analysis, as appropriate. LOS was compared by log-rank test and presented graphically by Kaplan-Meier survival curves. A p-value < 0.05 was considered statistically significant.Results The most common procedures performed through ML were resection of the small bowel or colon, closure of hollow viscus perforation or rupture, and adhesiolysis. Employment of ML was associated with reduced LOS (p = 0.0002), shorter OT (p = 0.0003), and minimised need for opioid analgesia (p = 0.01); however, the difference in postoperative complications was not statistically significant (ML: 21% versus SL: 27%, p = 0.57), and mortality was similar (6% in each group).Conclusions As our data showed, ML is a feasible and safe technique that could be used in emergency visceral surgery and abdominal trauma in well-selected patients. Having comparable postoperative morbidity with the SL approach, it might lead to reduced pain and enhanced recovery after the procedure. We proposed an algorithm for the selection of exploration method in patients presented with acute abdominal conditions that could be of help to acute care surgeon operating in a resource-limited setting.

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“…[ 3 ] A propensity score-matched analysis of 45 patients who underwent transcolonic natural orifice specimen extraction after right hemicolectomy for ascending colon cancer showed less postoperative pain, less need for analgesia, and a lower inflammatory response, while the 3-year overall survival was the same. [ 4 ] Therefore, the use of this method in segmental colonic resection with complete mesocolon excision for colon cancer, and its oncological safety, is promising, but requires further study.…”

mentioning

confidence: 99%

Natural orifice specimen extraction surgery (NOSES) for colon cancer treatment: a double-center case-matched study of surgical and short-term postoperative outcomes

Tsarkov

Liu

Zubayraeva

et al. 2023

Chinese Medical Journal

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Propensity score–matched comparison between totally laparoscopic right hemicolectomy with transcolonic natural orifice specimen extraction and conventional laparoscopic surgery with mini-laparotomy in the treatment of ascending colon cancer (with video)

Cited by 9 publications

References 22 publications

Effectiveness and safety of self-pulling and latter transection reconstruction in totally laparoscopic right hemicolectomy

Effectiveness and safety of self-pulling and latter transection reconstruction in totally laparoscopic right hemicolectomy

Mini-laparotomy in emergency general surgery in a second-level hospital in Zambia: a prospective cohort study

Natural orifice specimen extraction surgery (NOSES) for colon cancer treatment: a double-center case-matched study of surgical and short-term postoperative outcomes

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