Page 36 - Journal of WALS

WJOLS

10.5005/jp-journals-10007-1125
REVIEW ARTICLE Laparoscopic Surgery for Colorectal Cancers: Current Status
Laparoscopic Surgery for Colorectal Cancers:

Current Status

Sagar Basanale
Associate Professor, MNR Medical College, Sangareddy, NTR University, Member of World Association of Laparoscopic Surgery (WALS)
Member of Surgeon Association of India, Member of Indian Medical Association (IMA)

ABSTRACT
Background: Minimal access surgery short-term benefits of laparoscopy for colorectal cancer, such as faster bowel function recovery,
less postoperative pain and shorter hospitalization based on data organized according to levels of evidence.
Purpose: To understand the long-term benefits of laparoscopy for colon cancer with regard to recurrence and survival based on data
organized according to levels of evidence. To review the literature of laparoscopic surgery for colorectal cancers and its current status
in purely laparoscopic, laparoscopic assisted, hand-assisted laparoscopic surgery (HALS).
Materials and methods: A literature search was performed using search engine Google, HighWire Press and Online Springer Library
facility available at World Laparoscopy Hospital. The following search terms were used: Laparoscopic surgery for colorectal cancer
current status. Selected papers were screened for further references, operative procedure were selected, only if they are universally
accepted procedures, and the institution where the study was done is specialized institution for laparoscopic surgery.
Conclusions: In selected patients, a laparoscopic resection for colorectal cancer produces acceptable intermediate to long-term
oncologic outcomes and a low long-term complication rate.
Keywords: Laparoscopy, Colorectal, Colon, Cancer, Survival, Outcomes, Audit.

INTRODUCTION flexure was first carried out after placing the patient in the
antitrendelenburg position with inclination to the right. After
Since Jacob’s first laparoscopic colectomy in 1991, there are
various reports in literature suggesting that minimal access the patient was placed in the trendelenburg position, dissection
surgery is probably the way forward in colorectal surgery. was performed with ligature of the inferior mesenteric vessels
at the site of origin, respecting the left colic vein, whenever
We must discuss colonic and rectal cancers as two separate
diseases though a lot of concerns are going to be common. possible (Fig. 2). Dissection was then made by the avascular
plane, performing rectosigmoid dissection with total mesorectal
Laparoscopy as a tool can be used in two ways:
a. Thorough abdominal cavity exploration with simultaneous excision (TME) in tumors of the middle and lower thirds (LAR)
and mesorectal excision up to 5 cm below the lesion in tumors
staging of disease with the help of intraoperative ultrasound
b. Intraoperative ultrasound can diagnose liver metastasis of the upper third (AR). After completion of the pelvic
dissection, the distal end was sectioned using an EndoGIA-
which may have been missed by routine preoperative type mechanical suturing device. The assistance incision was
imaging techniques. This may not alter the plan of resection made at the suprapubic level (Pfannenstiel incision) with a length
of primary disease but intent of resection may change.
of 5 to 7 cm, according to the size of the tumor. Intracorporal
Laparoscopic colorectal surgery can be done in three
ways:
a. Purely laparoscopic
b. Laparoscopic assisted
c. Hand-assisted laparoscopic surgery (HALS).

SURGICAL PROCEDURE
An empty digestive tract facilitates the layering of intestinal
loops. It is achieved by a strict, fiber-free diet 8 days prior to
surgery. Polyethylene glycol is prescribed 2 days before surgery
to complete the intestinal preparation.
The patients were placed in a modified lithotomy position,
and a pneumoperitoneum was established with a Veress needle,
maintaining intra-abdominal pressure at 12 to 15 mm Hg. Four
or five trocars were placed (Fig. 1). The descent of the splenic Fig:1: Working port

World Journal of Laparoscopic Surgery, May-August 2011;4(2):103-108 103