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Laparoscopic proctectomy

Jeffrey N Harr, Samuel Luka, Aman Kankaria, Yen-Yi Juo, Samir Agarwal, Vincent Obias
BACKGROUND: Reports demonstrate laparoscopic colorectal surgery in obese patients is associated with higher conversion to laparotomy and complication rates. While several advantages of robotic-assisted surgery have been reported, outcomes in obese patients have not been adequately studied. Therefore, this study compares outcomes of robotic-assisted surgery in non-obese and obese patients. METHODS: A retrospective review of 331 consecutive robotic procedures performed at a single institution between 2009 and 2015 was performed...
October 27, 2016: Surgical Endoscopy
Haijun Deng, Dong Liu, Xiangming Mao, Xiaoliang Lan, Hao Liu, Guoxin Li
The current study sought to clarify the role of phosphodiesterase type 5 inhibitors (PDE-5i) and a vacuum erection device (VED) in penile rehabilitation after laparoscopic nerve-preserving radical proctectomy (LNRP) for rectal cancer. Participants were assigned to one of the following arms-no-intervention, nightly use of sildenafil 25 mg for 3 months after surgery, or concurrent use of nightly sildenafil 25 mg/day for 3 months and a vacuum erection device (VED) 10 to 15 minutes/day for 3 months-in a nonrandomized fashion...
August 24, 2016: American Journal of Men's Health
Jeremie Zeitoun, Benjamin Menahem, Audrey Fohlen, Gil Lebreton, Jean Lubrano, Arnaud Alves
A 61-year-old man presented via the emergency department with a few days history of abdominal and colic occlusion symptoms. He presented signs of sepsis, midline lumbar spine tenderness and reduced hip flexion. Computer tomography of the abdomen and pelvis showed a presacral collection contiguous with the posterior part of the colo-rectal anastomosis, and MRI lumbar spine revealed abscess invation into the epidural space. He underwent a laparotomy with washout of the presacral abscess and a colostomy with a prolonged course of intravenous antibiotic therapy...
2016: Journal of Surgical Case Reports
Ahmet Rencuzogullari, Luca Stocchi, Meagan Costedio, Emre Gorgun, Hermann Kessler, Feza H Remzi
BACKGROUND: Previous work from our institution has characterized the learning curve for open ileal pouch-anal anastomosis (IPAA). The purpose of the present study was to assess the learning curve of minimally invasive IPAA. METHODS: Perioperative outcomes of 372 minimally invasive IPAA by 20 surgeons (10 high-volume vs. 10 low-volume surgeons) during 2002-2013, included in a prospectively maintained database, were assessed. Predicted outcome models were constructed using perioperative variables selected by stepwise logistic regression, using Akaike's information criterion...
July 12, 2016: Surgical Endoscopy
Anass Mohammed Majbar, Mourad Abid, Mouna Alaoui, Farid Sabbah, Mohamed Raiss, Mohamed Ahallat, Abdelmalek Hrora
BACKGROUND: The impact of conversion to open surgery after a laparoscopic resection for rectal adenocarcinoma on postoperative morbidity is still unclear. Most previous studies included colon and rectal carcinomas and produced conflicting results. The aim of this study was to investigate the impact of conversion to open surgery on early postoperative morbidity in patients who underwent a laparoscopic resection for rectal adenocarcinoma. METHODS: This was a retrospective bicentric study...
September 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Ashraf Saad Zaghloul, Ahmed Mostafa Mahmoud
BACKGROUND: The available literature on minimally invasive colorectal cancer demonstrates that laparoscopic approach is feasible and associated with better short term outcomes than open surgery while maintaining equivalent oncologic safety. Reports have shown that robotic surgery may overcome some of the pitfalls of laparoscopic intervention. OBJECTIVE OF THE WORK: To evaluate early results of robotic colorectal surgery, in a cohort of Egyptian patients, regarding operative time, operative and early post-operative complications, hospital stay and pathological results...
September 2016: Journal of the Egyptian National Cancer Institute
Hong-Bo Wei, Jia-Feng Fang, Zong-Heng Zheng, Bo Wei, Jiang-Long Huang, Tu-Feng Chen, Yong Huang, Pu-Run Lei
The aim of this study was to investigate the effect of preservation of Denonvilliers' fascia (DF) during laparoscopic resection for mid-low rectal cancer on protection of male urogenital function. Whether preservation of DF during TME is effective for protection of urogenital function is largely elusive.Seventy-four cases of male mid-low rectal cancer were included. Radical laparoscopic proctectomy was performed, containing 38 cases of preservation of DF (P-group) and 36 cases of resection of DF (R-group) intraoperatively...
June 2016: Medicine (Baltimore)
Ahmet Rencuzogullari, Emre Gorgun, Meagan Costedio, Erman Aytac, Hermann Kessler, Maher A Abbas, Feza H Remzi
The present study reports an early institutional experience with robotic proctectomy (RP) and outcome comparison with laparoscopic proctectomy (LP) in patients with inflammatory bowel disease (IBD). Patients who underwent either RP or LP during proctocolectomy for IBD between January 2010 and June 2014 were matched (1:1) and reviewed. Twenty-one patients undergoing RP fulfilled the study criteria and were matched with an equal number of patients who had LP. Operative time was longer (304 vs. 213 min, P=0.008) and estimated blood loss was higher in the RP group (360 vs...
June 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Haane Massarotti, Fabio Rodrigues, Colin O'Rourke, Sami A Chadi, Steven Wexner
AIM: The study aimed to determine whether laparoscopic volume and type of training influence conversion during elective laparoscopic colorectal surgery. METHOD: An Institutional Review Board-approved prospective database was reviewed for patients who underwent colorectal resection by six colorectal surgeons for all diagnoses from 2009-2014. Surgeons were designated as laparoscopic- or open-trained based on formal laparoscopic colorectal surgery training, and classified as low laparoscopic volume (LLV) (<100 procedures) or high laparoscopic volume (HLV) (>100 procedures)...
May 28, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Jorge Silva-Velazco, David W Dietz, Luca Stocchi, Meagan Costedio, Emre Gorgun, Matthew F Kalady, Hermann Kessler, Ian C Lavery, Feza H Remzi
OBJECTIVE: The aim of the study was to compare value (outcomes/costs) of proctectomy in patients with rectal cancer by 3 approaches: open, laparoscopic, and robotic. BACKGROUND: The role of minimally invasive proctectomy in rectal cancer is controversial. In the era of value-based medicine, costs must be considered along with outcomes. METHODS: Primary rectal cancer patients undergoing curative intent proctectomy at our institution between 2010 and 2014 were included...
May 26, 2016: Annals of Surgery
Stefan D Holubar, Rachel K Brickman, Spencer W Greaves, S Joga Ivatury
BACKGROUND: Neoadjuvant radiotherapy (RT) for rectal cancer may increase wound complications after oncologic proctectomy. We aimed to assess the relationship between neoadjuvant RT and 30-day wound complications after radical surgery for rectal cancer. STUDY DESIGN: We identified rectal cancer patients (International Classification of Diseases, revision-9 [ICD-9] code 154.1) who underwent radical resection, using NSQIP from 2005 to 2010. Patients were stratified into preoperative radiation vs no radiation groups...
August 2016: Journal of the American College of Surgeons
C A Leo, S Samaranayake, Z L Perry-Woodford, L Vitone, O Faiz, J D Hodgkinson, I Shaikh, J Warusavitarne
AIM: Laparoscopic surgery is well established for colon cancer, with defined benefits. Use of laparoscopy for the performance of restorative proctocolectomy (RPC) with ileoanal anastomosis is more controversial. Technical aspects include difficult dissection of the distal rectum and a potentially increased risk of anastomotic leakage through multiple firings of the stapler. In an attempt to overcome these difficulties we have used the technique of transanal rectal excision to perform the proctectomy...
December 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Pierre-Emmanuel Colombo, Martin M Bertrand, Mathias Alline, Eric Boulay, Anne Mourregot, Sébastien Carrère, François Quénet, Marta Jarlier, Philippe Rouanet
BACKGROUND: Robotic total mesorectal excision (R-TME), a novel way for minimally invasive treatment of rectal cancer, was shown in previous studies to be safe and effective. However, comparison with laparoscopic total mesorectal excision (L-TME) has drawn contradictory disputes, especially concerning operative high-risk patients. The aim of this study was to compare R-TME and L-TME on the rectal technical approach. METHODS: Between October 2009 and March 2013, a total of 120 consecutive rectal carcinomas, operated for sphincter-saving procedure, were enrolled...
May 2016: Annals of Surgical Oncology
Elisabeth C McLemore, Christina R Harnsberger, Ryan C Broderick, Hyuma Leland, Patricia Sylla, Alisa M Coker, Hans F Fuchs, Garth R Jacobsen, Bryan Sandler, Vikram Attaluri, Anna T Tsay, Steven D Wexner, Mark A Talamini, Santiago Horgan
BACKGROUND: With increasing interest in natural orifice surgery, there has been a dramatic evolution of transanal and endoluminal surgical techniques. These techniques began with transanal endoluminal surgical removal of rectal masses and have progressed to transanal radical proctectomy for rectal cancer. The first transanal total mesorectal excision (taTME) was performed in 2009 by Sylla, Rattner, Delgado, and Lacy. The improved visibility and working space associated with the taTME technique is intriguing...
September 2016: Surgical Endoscopy
Grace Clara Lee, Patricia Sylla
Since the advent of laparoscopy, minimally invasive techniques such as single port laparoscopy, robotics, endoscopically assisted laparoscopy, and transanal endoscopic surgery continue to revolutionize the field of colorectal surgery. Transanal natural orifice transluminal endoscopic surgery (NOTES) represents a further paradigm shift by combining the advantages of these earlier techniques to reduce the size and number of abdominal incisions and potentially optimize rectal dissection, especially with respect to performance of an oncologically adequate total mesorectal excision (TME) for rectal cancer...
September 2015: Clinics in Colon and Rectal Surgery
Tomohiro Yamaguchi, Yusuke Kinugasa, Akio Shiomi, Hiroyuki Tomioka, Hiroyasu Kagawa, Yushi Yamakawa
PURPOSES: Several retrospective studies have demonstrated the safety and technical feasibility of robotic-assisted laparoscopic surgery (RALS). The aim of the present study was to clarify the advantages of RALS for rectal cancer by comparing its short-term outcomes with those of conventional laparoscopic surgery (CLS). METHODS: Between April, 2010 and April, 2015, a total of 974 patients underwent proctectomy for rectal cancer. After the exclusion of those who underwent open surgery, high anterior resection, lateral lymph node dissection, or multiple resection, 442 patients were enrolled in this study, including 203 who underwent RALS and 239 who underwent CLS...
August 2016: Surgery Today
Aaron S Rickles, David W Dietz, George J Chang, Steven D Wexner, Mariana E Berho, Feza H Remzi, Frederick L Greene, James W Fleshman, Maher A Abbas, Walter Peters, Katia Noyes, John R T Monson, Fergal J Fleming
OBJECTIVES: To identify predictors of positive circumferential resection margin following rectal cancer resection in the United States. BACKGROUND: Positive circumferential resection margin is associated with a high rate of local recurrence and poor morbidity and mortality for rectal cancer patients. Prior study has shown poor compliance with national rectal cancer guidelines, but whether this finding is reflected in patient outcomes has yet to be shown. METHODS: Patients who underwent resection for stage I-III rectal cancer were identified from the 2010-2011 National Cancer Database...
December 2015: Annals of Surgery
James Fleshman, Megan Branda, Daniel J Sargent, Anne Marie Boller, Virgilio George, Maher Abbas, Walter R Peters, Dipen Maun, George Chang, Alan Herline, Alessandro Fichera, Matthew Mutch, Steven Wexner, Mark Whiteford, John Marks, Elisa Birnbaum, David Margolin, David Larson, Peter Marcello, Mitchell Posner, Thomas Read, John Monson, Sherry M Wren, Peter W T Pisters, Heidi Nelson
IMPORTANCE: Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease. OBJECTIVE: To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, balanced, noninferiority, randomized trial enrolled patients between October 2008 and September 2013...
October 6, 2015: JAMA: the Journal of the American Medical Association
R T Pasam, I O Esemuede, S A Lee-Kong, R P Kiran
BACKGROUND: While laparoscopic colorectal resection may be underused in technically challenging circumstances, the minimally invasive approach may in fact maximally benefit patients at the greatest risk of complications. Obesity and proctectomy pose particular technical challenges during laparoscopic resection and are also associated with the greatest risks of complications, especially surgical site infections (SSIs). We evaluated the role of laparoscopy in minimizing SSI in such patients...
December 2015: Techniques in Coloproctology
J-F Fang, B Wei, Z-H Zheng, T-F Chen, Y Huang, J-L Huang, P-R Lei, H-B Wei
AIM: This study assessed the effect of intra-operative electrical nerve stimulation (INS) on pelvic autonomic nerve preservation (PANP) during laparoscopic resection for rectal cancer. METHOD: A total of 189 consecutive cases of radical laparoscopic proctectomy were included. PANP was assessed visually or with INS. Urinary function was evaluated by residual urine volume (RUV), International Prostatic Symptom Score (IPSS) and recatheterization rate. Erectile function was evaluated using the International Index of Erectile Function (IIEF-5) scale...
December 2015: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
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