We have located links that may give you full text access.
Total laparoscopic right colectomy: The duodenal window first approach.
Surgical Oncology 2016 June
BACKGROUND: Total laparoscopic right colectomy (TLRC) is a demanding procedure requiring laparoscopic skills and expertise in surgical oncology. Identifying the correct plane of dissection may be difficult. A correct management of ileocecal and right colic vascular pedicles is pivotal to achieve an oncological resection and the adequate blood supply of ileal and colic stumps.
METHODS: We describe a technique for TLRC with a duodenum-first approach. Using three ports, dividing the "duodenal window", ileocecal and right colic vascular pedicles, and the right ureter are easily identified. The procedure is completed with an intracorporal stapled side-by-side anastomosis.
RESULTS: In 2014, 19 patients underwent TLRC using this technique. The median operative time was 178 min (132-237 min) and median intraoperative blood loss reached 60 mL (10-400). Conversion rate was 15.8%. No urinary tract, vascular, duodenal injury or anastomotic fistula were reported. Fifteen patients (79%) underwent a colectomy for cancer with a median of 16 (7-27) harvested lymph-nodes and 100% of R0-resection. Minor morbidity (Clavien-Dindo I-II) was 52.6% mainly related to cardiopulmonary complications (26.3%). Severe morbidity (Clavien-Dindo ≥ III) was 10.5% (two patients), including one reoperation (due to a sepsis related to an intra-abdominal abscess) and one death (due to complications of an aortic aneurism). Median hospital stay was 7 days (2-23 days). Long-term outcomes are unremarkable.
CONCLUSIONS: Using three trocars, the "duodenal window" approach to TLRC is technically feasible and safe, with good outcomes. The early access to the duodenum and the exposure of ilea-cecal and right colic pedicles rationalizes the procedure.
METHODS: We describe a technique for TLRC with a duodenum-first approach. Using three ports, dividing the "duodenal window", ileocecal and right colic vascular pedicles, and the right ureter are easily identified. The procedure is completed with an intracorporal stapled side-by-side anastomosis.
RESULTS: In 2014, 19 patients underwent TLRC using this technique. The median operative time was 178 min (132-237 min) and median intraoperative blood loss reached 60 mL (10-400). Conversion rate was 15.8%. No urinary tract, vascular, duodenal injury or anastomotic fistula were reported. Fifteen patients (79%) underwent a colectomy for cancer with a median of 16 (7-27) harvested lymph-nodes and 100% of R0-resection. Minor morbidity (Clavien-Dindo I-II) was 52.6% mainly related to cardiopulmonary complications (26.3%). Severe morbidity (Clavien-Dindo ≥ III) was 10.5% (two patients), including one reoperation (due to a sepsis related to an intra-abdominal abscess) and one death (due to complications of an aortic aneurism). Median hospital stay was 7 days (2-23 days). Long-term outcomes are unremarkable.
CONCLUSIONS: Using three trocars, the "duodenal window" approach to TLRC is technically feasible and safe, with good outcomes. The early access to the duodenum and the exposure of ilea-cecal and right colic pedicles rationalizes the procedure.
Full text links
Related Resources
Trending Papers
Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024 April 12
Proximal versus distal diuretics in congestive heart failure.Nephrology, Dialysis, Transplantation 2024 Februrary 30
World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management.American Journal of Hematology 2024 March 30
Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.Mental Health Clinician 2023 October
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app