Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis

Abstract

Laparoscopy has become widely accepted as the preferred surgical approach in the management of benign and malignant colorectal diseases. Once considered a relative contraindication in patients with prior abdominal surgery (PAS), as surgeons have continued to gain expertise in advanced laparoscopy, minimally invasive approaches have been increasingly incorporated in the reoperative abdomen and pelvis. Although earlier studies have described conversion rates, most contemporary series evaluating the impact of PAS in laparoscopic colorectal resection have reported equivalent conversion and morbidity rates between reoperative and non-reoperative cases, and series evaluating the impact of laparoscopy in reoperative cases have demonstrated improved short-term outcomes with laparoscopy. The data overall highlight the importance of case selection, careful preoperative preparation and planning, and the critical role of surgeons' expertise in advanced laparoscopic techniques. Challenges to the widespread adoption of minimally invasive techniques in reoperative colorectal cases include the longer learning curve and longer operative time. However, with the steady increase in adoption of minimally invasive techniques worldwide, minimally invasive surgery (MIS) is likely to continue to be applied in the management of increasingly complex reoperative colorectal cases in an effort to improve patient outcomes. In the hands of experienced MIS surgeons and in carefully selected cases, laparoscopy is both safe and efficacious for reoperative procedures in the abdomen and pelvis, with measurable short-term benefits.

Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease

“…Laparoscopic surgery can also be used during reoperation. 5 Laparoscopic reoperation is feasible for the treatment of many complications following major laparoscopic abdominal surgery. 6 However, there is no report about the role of repeat single incision laparoscopic surgery (R-SILS).…”

“…Even though the initial approach started with a single port, additional trocar or conversion to the conventional multiport laparoscopic surgery should be considered if there is technical difficulty or a poor operative field. 5,9 We converted to multiport laparoscopic surgery and open surgery due to massive adhesion and poor vision. It was difficult to use the previous post site in the emergent group, which is more relevant to postoperative complications requiring treatment, and food progression and extension of the hospitalization period were confirmed.…”

Case of the Month from Peter MacCallum Cancer Centre, Melbourne, Australia: ICG‐assisted robotic Boari flap ureteric reimplantation in a case of missed ureteric injury

“…Prior abdominal surgery has traditionally been a relative contraindication for minimally invasive surgery (MIS) based on worse outcomes in early series (higher re-operation rates, blood loss, anastomotic leaks and hospital stay) [21,22]. Burgeoning experience in MIS globally has led to improved outcomes and greater adoption in complex, re-operative cases [23]. MIS can offer some advantages in re-operative cases.…”

Is Laparoscopy Underutilized for Sigmoid Volvulus?

“…1,6 However, the use of minimally invasive surgery for colorectal benign and malignant pathology has become increasingly prevalent since its introduction. 1,[15][16][17][18][19] The benefits of laparoscopy in colorectal surgery are well established. Use of laparoscopy has been associated with decreased overall mortality, morbidity, length of hospital stay, and overall costs when compared with open colorectal procedures.…”

“…The majority of colectomies for volvulus are still performed via open technique 1,6. However, the use of minimally invasive surgery for colorectal benign and malignant pathology has become increasingly prevalent since its introduction 1,15–19. The benefits of laparoscopy in colorectal surgery are well established.…”