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Laparoscopic Left Colectomy

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Abstract

Colorectal cancer, the 3rd most common cancer worldwide, is generally treated with surgical resection. The data for the laparoscopic approach to colon resection has revealed several advantages over the open technique including shorter hospital stay, reduced length of postoperative ileus, earlier resumption of oral nutritional intake, reduced surgical pain, and improved cosmesis. Furthermore, there is no difference in oncologic outcomes between open and laparoscopic colectomy. These advantages have led to an increasing use of the laparoscopic technique for colon resection. In this chapter, we discuss the key operative steps necessary to a successful laparoscopic left colectomy, highlighting anatomical and preoperative considerations, key factors of the operative technique, and postoperative management and its complications.

Keywords

  • Laparoscopic hemicolectomy
  • Minimally invasive colectomy
  • Colon cancer
  • Inferior mesenteric vein
  • Inferior mesenteric artery

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References

  1. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359(9325):2224–9. doi:10.1016/s0140-6736(02)09290-5.

    PubMed  CrossRef  Google Scholar 

  2. Laparoscopically assisted colectomy is as safe and effective as open colectomy in people with colon cancer Abstracted from: Nelson H, Sargent D, Wieand HS, et al; for the Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350: 2050-2059. Cancer Treat Rev. 2004;30(8):707–9. doi:10.1016/j.ctrv.2004.09.001.

    Google Scholar 

  3. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26. doi:10.1016/s0140-6736(05)66545-2.

    PubMed  CrossRef  Google Scholar 

  4. Cirocco WC, Schwartzman A, Golub RW. Abdominal wall recurrence after laparoscopic colectomy for colon cancer. Surgery. 1994;116(5):842–6.

    CAS  PubMed  Google Scholar 

  5. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart Jr RW, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246(4):655–62. doi:10.1097/SLA.0b013e318155a762; discussion 62–4.

    PubMed  CrossRef  Google Scholar 

  6. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2009;10(1):44–52. doi:10.1016/s1470-2045(08)70310-3.

    PubMed  CrossRef  Google Scholar 

  7. Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100(1):75–82. doi:10.1002/bjs.8945.

    CAS  PubMed  CrossRef  Google Scholar 

  8. Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N. Is minimally invasive colon resection better than traditional approaches?: first comprehensive national examination with propensity score matching. JAMA Surg. 2014;149(2):177–84. doi:10.1001/jamasurg.2013.3660.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  9. Fowler DL, White SA. Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc. 1991;1(3):183–8.

    CAS  PubMed  Google Scholar 

  10. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1(3):144–50.

    CAS  PubMed  Google Scholar 

  11. Monson JR, Darzi A, Carey PD, Guillou PJ. Prospective evaluation of laparoscopic-assisted colectomy in an unselected group of patients. Lancet. 1992;340(8823):831–3.

    CAS  PubMed  CrossRef  Google Scholar 

  12. Rouffet F, Hay JM, Vacher B, Fingerhut A, Elhadad A, Flamant Y, et al. Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research. Dis Colon Rectum. 1994;37(7):651–9.

    CAS  PubMed  CrossRef  Google Scholar 

  13. Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg. 2011;254(6):868–75. doi:10.1097/SLA.0b013e31821fd1ce.

    PubMed  CrossRef  Google Scholar 

  14. Kwaan MR, Al-Refaie WB, Parsons HM, Chow CJ, Rothenberger DA, Habermann EB. Are right-sided colectomy outcomes different from left-sided colectomy outcomes?: study of patients with colon cancer in the ACS NSQIP database. JAMA Surg. 2013;148(6):504–10. doi:10.1001/jamasurg.2013.1205.

    PubMed  CrossRef  Google Scholar 

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Correspondence to Julio Garcia-Aguilar M.D., Ph.D. .

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In this video, the surgeon demonstrates his approach to laparoscopic left colectomy. (WMV 45614 kb)

Key Operative Steps

  1. 1.

    Place the patient in modified lithotomy position.

  2. 2.

    Create pneumoperitoneum using a Veress needle.

  3. 3.

    Use medial-to-lateral dissection approach.

  4. 4.

    Identify, isolate, and divide the inferior mesenteric vein.

  5. 5.

    Identify, isolate, and divide the inferior mesenteric artery after identifying and preserving the left ureter.

  6. 6.

    Dissect the mesocolon from the retroperitoneal structures.

  7. 7.

    Mobilize the descending and sigmoid colon from the lateral abdominal wall. Mobilize the greater omentum and splenic flexure

  8. 8.

    Transect the rectosigmoid colon.

  9. 9.

    Use a Pfannenstiel or periumbilical incision for specimen extraction using a wound protector.

  10. 10.

    Perform extracorporeal placement of an anvil after proximal division of the left colon.

  11. 11.

    Perform laparoscopic intracorporeal end-to-end anastomosis using a circular stapler.

  12. 12.

    Perform an air leak test.

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Samdani, T., Garcia-Aguilar, J. (2015). Laparoscopic Left Colectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_19

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_19

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