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Introduction: Laparoscopic resection of low rectal cancer poses significant technical difficulties for the surgeon. There is a lack of published follow-up data in relation to the surgical, oncological and survival outcomes in these patients. Aim: The aim of this study is to evaluate the surgical, oncological and survival outcomes in all patients undergoing laparoscopic resection for low rectal cancer. Methods: Consecutive patients undergoing laparoscopic resection for low rectal cancers were included in the study. Clinical, pathological and follow-up data were recorded over a 4-year period. The mean follow-up was 25 months Results: A total of 53 patients were included in the study, 30 of whom were males. The mean age was 64.14 years (range, 34-86 years). The mean hospital stay was 8.2 days (range, 4-42 days). Fifty were completed laparoscopically and three were converted to an open procedure. Thirty-eight were anterior resections and 15 were abdominoperineal resections. Twenty-four patients received neoadjuvant chemoradiotherapy. The total mesorectal excision was optimal in 51 (98%) cases. There were no anastomotic sequelae and no surgical mortality. There was no local recurrence detected. The overall survival (mean follow-up, 25 months) was 93.5%. Conclusion: Laparoscopic resection for low rectal cancers permits optimum oncological control. In our series, this technical approach is associated with excellent 4-year survival and clinical outcomes. [ABSTRACT FROM AUTHOR]

Enhanced recovery programmes (ERPs) have demonstrated reduced morbidity and length of hospital stay in patients undergoing open elective colorectal resections. The application of laparoscopic techniques to colorectal surgery is associated with shorter length of stay and morbidity compared to open resections. In the setting of laparoscopic surgery, it is unclear whether there is an additive effect on length of stay and morbidity by combining these. The current study addresses the benefit of an ERP (RAPID protocol) in a cohort of matched patients undergoing laparoscopic sigmoid colon resection Consecutive patients over a 40-month period who underwent laparoscopic sigmoid colon resection were assigned either to the RAPID protocol (group 1) or traditional post operative care (group 2) in a non-randomised manner. Analysis was on an “intention to treat” basis. Primary and secondary endpoints were identified; primary endpoints included length of hospital stay and readmission rate. Secondary endpoints included morbidity and mortality rate. Seventy-three consecutive patients were included. Group 1 included 37 patients. Group 2 included 36 patients. Median length of hospital stay in groups 1 and 2 was 5 and 8 days, respectively ( p = 0.01). Readmission rate in groups 1 and 2 was 8.1% and 8.3%, respectively ( p = 0.98). Morbidity rate in groups 1 and 2 was 30% and 22%, respectively ( p = 0.61); there was one mortality in each group. The application of the ERP (RAPID) to patients undergoing laparoscopic sigmoid colon resection results in a significant improvement in length of hospital stay, with comparable morbidity and readmission rates. [ABSTRACT FROM AUTHOR]

The objective of the study was to determine whether the metrics from a left-sided laparoscopic colectomy (LC) simulator could distinguish between the objectively scored performance of minimally invasive colorectal expert and novice surgeons. We report our results from the first virtual reality-based laparoscopic colorectal training course for experienced laparoscopic surgeons. Eleven surgeons, experienced but novice in LC, constituted the novice group, and three experienced laparoscopic colorectal surgeons (>300 LCs) served as our experts. Novice subjects received didactic educational sessions and instruction in practice of LC from the experts. All subjects received instruction, demonstration, and supervision on the surgical technique to perform a LC on the simulator. All subjects then performed a laparoscopic colectomy on the simulator. Experts performed the same case as the novices. Outcomes measured by the simulator were time to perform the procedure, instrument path length, and smoothness of the trajectory of the instruments. Anatomy trays from the simulator were objectively scored for explicitly predefined intraoperative errors after each procedure. Expert surgeons performed significantly better then the novice colorectal surgeons with regard to instrument path length, instrument smoothness, and time taken to complete the procedure. Of the 13 predetermined errors, experts made significantly fewer errors in total then the novices (mean score 2.67 versus 4.7, p = 0.03), and performed better in 8 out of 13 errors. The parameters assessed by the ProMIS VR simulator for laparoscopic colorectal training distinguished between novice and expert colorectal surgeons, despite using otherwise experienced novices who had extensive training before the procedure and expert mentoring during it. Experts performed the simulated procedure significantly faster with more efficient use of their instruments, and made fewer intraoperative errors. Thus the simulator demonstrated construct validity. [ABSTRACT FROM AUTHOR]