Page 22 - Laparoscopic Surgery Online Journal

Manash Ranjan Sahoo et al

excision of rectal cancer was found to be equivalent in recovery, with an equivalent tumor clearance, morbidity,
achieving distal and radial negative margins. Adequacy of mortality, disease-free interval and duration of survival. 21
radial resection can also be measured by ability to achieve One final consideration that has to be made regarding
high ligation, specimen characteristics and lymph node yield laparoscopic surgery is cost effectiveness. Indeed,
which in many recent studies have shown to be comparable laparoscopic procedure itself is more expensive than
15
in open and laparoscopic group. Port site recurrences were conventional techniques because of the use of single use
as infrequent as incisional metastases in these studies, trocars and endoluminal staplers. However, when one takes
making it very likely that port site metastases in earlier into account ICU stay and overall hospital stay laparoscopic
reports were due to technical failure rather than to inherent procedure is significantly superior, bringing considerable
problems with laparoscopy. savings to the budget.
Three factors have stimulated the development of The difficulty in operating, resecting, anastomosing in
laparoscopic surgery for rectal cancer. Firstly, the technical pelvic cavity has led nowadays robotic surgeries to overtake
difficulty of rectal dissections in a narrow pelvis, especially conventional laparoscopic surgery.
in male patients. Secondly, the inherent benefit of improved To date, all reported comparative nonrandomized studies
fine instruments and the improved visualization provided and randomized studies have shown no difference in
by the laparoscopic camera during pelvic dissection. Thirdly, recurrence and survival rates with laparoscopic vs open
colorectal resection, and a lower overall morbidity with
the possibility to better dissect the rectum up to the pelvic
laparoscopic procedure. 19 Wise selection of appropriate
floor in order to perform a coloanal anastomosis, avoiding
cases should guide the novice in advanced laparoscopic
an abdominoperineal resection, in selected patients with very
surgery. With development of improved techniques and
low rectal cancer.
more experience, operating time can gradually be reduced
Laparoscopic colorectal surgery invariably takes longer
with improved outcomes.
time than a corresponding open procedure. This was true at
the beginning of the learning curve, but many surgeons CONCLUSION
would disagree with this with the current level of expertize.
Our results suggest that laparoscopic resection for rectal
Our study also confirmed the low rate of postoperative
cancer can be performed safely and without compromising
complications after minimally invasive procedures.
oncological principles. There are definitely improved short-
Postoperative ileus, urinary retention, and wound infections
term outcomes with laparoscopic surgery.
occurred less frequently than that in the open resection
group. These advantages have also been confirmed by many REFERENCES
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