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Yi Zhang,&ast; Yiqing Guo,&ast; Chao Gong, Junzuo Fu, Lianhua Chen Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Junzuo Fu; Lianhua Chen, Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, No. 100 Haining Road, Shanghai, 200080, People’s Republic of China, Tel +86-21-63240090, Email Fujunzuo021@163.com; emily19941010@126.comBackground: The positive roles of deep muscle relaxation in abdominal surgeries and transversus abdominis plane block (TAPB) in the postoperative analgesia. This study aimed to discuss the effects of TAPB on abdominal muscle relaxation, the intraoperative diaphragmatic, and the respiratory functions.Methods: The patients were randomly divided into the TAPB group who received single-shot TAPB bilaterally (n=30), and the control group who did not receive TAPB (n=30). Both groups keep the same steps for other procedures in the surgeries and anesthesia. Four time points for monitoring were defined: The moment when pneumoperitoneum pressure stabilized following endotracheal intubation and anesthetic induction (T0), appearance of the first incisure in the pressure-volume (P-V) loop (T1), appearance of the second incisure in the P-V loop (T2), and the moment with single stimulation (SS) =20% (T3). Primary observation parameters were SS1 measured by muscle relaxation monitoring at T1, and SS2 at T2. Secondary observation parameters included surgeon’s satisfaction with surgical field and respiratory dynamics at the four time points.Results: The two groups were comparable in age, gender, BMI, ASA grade, and operation time. The TAPB group had a dramatic reduction in the total dose of intraoperative sufentanil (0.73± 0.21 ug/kg) compared with the control group (0.87± 0.18 ug/kg) (P=0.023); Other use of drug did not differ between the two groups. The two groups did not differ significantly in SS at either T1 (SS1) or T2 (SS2). In either group, surgeon’s satisfaction with surgical field at T1 and T2 decreased dramatically compared with T0 and T3 (all P< 0.05). At each time point, the respiratory dynamics and the surgeon’s satisfaction with surgical field did not differ significantly between the two groups.Conclusion: TAPB reduced the use of intraoperative analgesics without altering the degree of abdominal relaxation, or affecting surgeon’s satisfaction with surgical field in the patients receiving laparoscopic colorectal surgery.Keywords: Transversus abdominis plane block, deep muscle relaxation, analgesia, laparoscopic colorectal surgery

Since the early1990s, laparoscopic right colon resections have been the most performed advanced laparoscopic procedures just after laparoscopic left colectomies and sigmoid resections. Indications for laparoscopic right colectomies are either benign or malignant diseases. Despite its many indications, a laparoscopic right or extended right colectomy is mostly performed for cancer of the caecum, the ascending colon, the hepatic flexure or the proximal transverse colon. Worldwide, colorectal cancer is the third most diagnosed cancer: an estimated 1,880,725 people were diagnosed with colorectal cancer in 2020, out of which 1,148,515 were colon cancer cases and 40% were located in the right colon. These figures make an oncologic sound surgery for right colon cancer of the utmost relevance. More recently, complete mesocolic excision has been advocated as the optimal choice in term of radicality, especially in node-positive patients with right colon cancer. Laparoscopic standard right colectomy and extended right colectomy with or without CME should be performed according to defined principles based on a close knowledge of key anatomical landmarks. This knowledge will allow to trace anatomical structures and drive instruments along the correct surgical planes and has its foundations in teachings from surgeons and scientists of past and present time. [ABSTRACT FROM AUTHOR]

Background: To evaluate outcomes of low with high intraabdominal pressure during laparoscopic colorectal resection surgery. Methods: A systematic search of multiple electronic data sources was conducted, and all studies comparing low with high (standard) intraabdominal pressures were included. Our primary outcomes were post-operative ileus occurrence and return of bowel movement/flatus. The evaluated secondary outcomes included: total operative time, post-operative haemorrhage, anastomotic leak, pneumonia, surgical site infection, overall post-operative complications (categorised by Clavien-Dindo grading), and length of hospital stay. Revman 5.4 was used for data analysis. Results: Six randomised controlled trials (RCTs) and one observational study with a total of 771 patients (370 surgery at low intraabdominal pressure and 401 at high pressures) were included. There was no statistically significant difference in all the measured outcomes; post-operative ileus [OR 0.80; CI (0.42, 1.52), P = 0.50], time-to-pass flatus [OR -4.31; CI (-12.12, 3.50), P = 0.28], total operative time [OR 0.40; CI (-10.19, 11.00), P = 0.94], post-operative haemorrhage [OR 1.51; CI (0.41, 5.58, P = 0.53], anastomotic leak [OR 1.14; CI (0.26, 4.91), P = 0.86], pneumonia [OR 1.15; CI (0.22, 6.09), P = 0.87], SSI [OR 0.69; CI (0.19, 2.47), P = 0.57], overall post-operative complications [OR 0.82; CI (0.52, 1.30), P = 0.40], Clavien-Dindo grade ≥ 3 [OR 1.27; CI (0.59, 2.77), P = 0.54], and length of hospital stay [OR -0.68; CI (-1.61, 0.24), P = 0.15]. Conclusion: Low intraabdominal pressure is safe and feasible approach to laparoscopic colorectal resection surgery with non-inferior outcomes to standard or high pressures. More robust and well-powered RCTs are needed to consolidate the potential benefits of low over high pressure intra-abdominal surgery. [ABSTRACT FROM AUTHOR]

Abstract Purpose The addition of intrathecal morphine to general anesthesia for laparoscopic colorectal surgery is an effective method of providing analgesia. However, the analgesia duration of approximately 24 hours poses the risk of rebound pain on the second postoperative day. Therefore, this study aimed to investigate the patients' perception on postoperative pain management using the International Pain Outcomes questionnaire on both the first and second postoperative day. Methods This prospective single-center cohort study was conducted between November 2020 and March 2021 and included forty patients. The primary outcome was a difference in postoperative pain on the first and second postoperative day. Secondary outcomes included opioid consumption, interference of pain with activities, side effects, and patients’ perception and satisfaction with pain treatment. Results The intensity of postoperative pain did not increase on the second postoperative day NRS [numeric rating scale] 5 (2–7 [0–10]) vs 5 (3–7 [1–10]), p=0.414), but the percentage of time spent in severe pain increased (20% (10-40 [0-90]) vs 30% (20-50 [0-80]), p=0.010). There was no difference in opioid consumption (6 mg (0–12) [0–42] vs 6 mg (0–12) [0–29], p=0.914). Pruritis (NRS 2 (0–6 [0–10]) vs 0 (0–3 [0–8]), p=0.001) and dizziness (NRS 2 (0–7 [0–10]) vs 0 (0–2 [0–9]), p=0.002) decreased on the second postoperative day. Patients reported high satisfaction during the first two days after surgery (NRS 8 (7–9) [0–10] vs 8 (7–9) [0–10], p=0.395). Conclusion Intrathecal morphine is a suitable analgesic modality in laparoscopic colorectal surgery within an enhanced recovery after surgery program, without causing important rebound pain. Pain scores, however, may be further reduced by adding non-opioid analgesics.

Purpose: The addition of intrathecal morphine to general anesthesia for laparoscopic colorectal surgery is an effective method of providing analgesia. However, the analgesia duration of approximately 24 hours poses the risk of rebound pain on the second postoperative day. Therefore, this study aimed to investigate the patients' perception on postoperative pain management using the International Pain Outcomes questionnaire on both the first and second postoperative day. Methods: This prospective single-center cohort study was conducted between November 2020 and March 2021 and included forty patients. The primary outcome was a difference in postoperative pain on the first and second postoperative day. Secondary outcomes included opioid consumption, interference of pain with activities, side effects, and patients’ perception and satisfaction with pain treatment. Results: The intensity of postoperative pain did not increase on the second postoperative day NRS [numeric rating scale] 5 (2–7 [0–10]) vs 5 (3–7 [1–10]), p=0.414), but the percentage of time spent in severe pain increased (20% (10-40 [0-90]) vs 30% (20-50 [0-80]), p=0.010). There was no difference in opioid consumption (6 mg (0–12) [0–42] vs 6 mg (0–12) [0–29], p=0.914). Pruritis (NRS 2 (0–6 [0–10]) vs 0 (0–3 [0–8]), p=0.001) and dizziness (NRS 2 (0–7 [0–10]) vs 0 (0–2 [0–9]), p=0.002) decreased on the second postoperative day. Patients reported high satisfaction during the first two days after surgery (NRS 8 (7–9) [0–10] vs 8 (7–9) [0–10], p=0.395). Conclusion: Intrathecal morphine is a suitable analgesic modality in laparoscopic colorectal surgery within an enhanced recovery after surgery program, without causing important rebound pain. Pain scores, however, may be further reduced by adding non-opioid analgesics. [ABSTRACT FROM AUTHOR]

Aim: Natural orifice specimen extraction (NOSE) in left‐sided colorectal surgery requires application of the circular stapler anvil to the proximal bowel without exteriorization through an additional abdominal incision. We describe an intracorporeal method to secure the stapler anvil, termed the intracorporeal antimesenteric ancillary trocar (IAAT) technique. Method: The ancillary trocar is attached to the stapler anvil before introduction into the abdominal cavity through the anal or vaginal orifice. The colon is incised before the trocar spike is brought out through the antimesenteric surface 3–4 cm within the cut edge. A linear stapler is used to seal the bowel end. The ancillary trocar is detached and retrieved via the NOSE conduit. Following the NOSE procedure, a side‐to‐end colorectal anastomosis is performed with the transanal circular stapler. Results: Ten consecutive patients underwent elective left‐sided colorectal resection with IAAT for NOSE (seven transanal, three transvaginal) from January to June 2023. Median age and body mass index were 66 (range 47–74) years and 24.3 (range 17.9–30.8) kg/m2 respectively. Two (20%) patients underwent sigmoid colectomy for sigmoid volvulus while eight (80%) underwent anterior resection for colorectal cancer. Median operating time, operative blood loss and postoperative length of hospital stay were 170 (range 140–240) min, 20 (range 10–40) mL and 1 (range 1–3) day respectively. There were no postoperative complications, readmissions or reoperations. Median follow‐up duration was 3 (range 1–6) months. Conclusion: The IAAT double‐stapling side‐to‐end anastomotic technique is safe and feasible for patients undergoing left‐sided colorectal resection with NOSE, resulting in good outcomes. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study aimed to examine the incidence of incisional hernia (IH) in elective laparoscopic colorectal surgery (LC) using regulated computed tomography (CT) images at intervals every 6 months. Methods We retrospectively examined the diagnosis of IH in patients who underwent LC for colorectal cancer at Kansai Medical University Hospital from January 2014 to August 2018. The diagnosis of IH was defined as loss of continuity of the fascia in the axial CT images. Results 470 patients were included in the analysis. IH was diagnosed in 47 cases at 1 year after LC. The IH size was 7.8 cm2 [1.3–55.6]. In total, 38 patients with IH underwent CT examination 6 months after LC, and 37 were already diagnosed with IH. The IH size was 4.1 cm2 [0–58.9]. The IH size increased in 17 cases between 6 months and 1 year postoperatively, and in 1 case, a new IH occurred. 47%(18/38) of them continued to grow until 1 year after LC. A multivariate analysis was performed on the risk of IH occurrence. SSI was most significantly associated with IH occurrence (OR:5.28 [2.14–13.05], p = 0.0003). Conclusion IH occurred in 10% and 7.9% at 1 year and 6 months after LC. By examining CT images taken for the postoperative surveillance of colorectal cancer, we were able to investigate the occurrence of IH in detail.

Abstract Background The risk of postoperative cognitive dysfunction(POCD) in laparoscopic surgery should not be overlooked. Intravenous lidocaine can reduce perioperative inflammatory response in patients undergoing laparoscopic surgery, while the effect of intraoperative intravenous lidocaine on postoperative cognitive function in patients undergoing laparoscopic colorectal cancer surgery has not been well studied. We investigated whether intraoperative lidocaine improves postoperative cognitive function after laparoscopic radical resection for colorectal cancer. Methods We conducted a prospective, randomized double blinded controlled trial to investigate the effect of intravenous lidocaine on rapid postoperative recovery in patients undergoing laparoscopic radical resection of colorectal cancer. The patients were randomly assigned to receive either intravenous lidocaine or saline. The primary outcome was cognitive dysfunction defined by a decrease from pre- to postoperative ≥ 2 of the Mini-Mental State Examination (MMSE) score, at the 3rd and the 7th postoperative days. Secondary outcomes were the MMSE raw score and parameters of the patients’ postoperative recovery such as agitation and length of stay in the post-anaesthesia care unit (PACU), length of hospital stay, markers of inflammation (white blood cell count and CRP), and incidence of complications. Results Seventy-three patients in the lidocaine group and 77 patients in the control group completed the trial. The rate of cognitive dysfunction was lower in the lidocaine group than that in the control group, both at the 3rd (18.57% vs. 63.64% for each group respectively; RR = 0.26, 95%CI = 0.19–0.32; p

Purpose: This study aimed to examine the incidence of incisional hernia (IH) in elective laparoscopic colorectal surgery (LC) using regulated computed tomography (CT) images at intervals every 6 months. Methods: We retrospectively examined the diagnosis of IH in patients who underwent LC for colorectal cancer at Kansai Medical University Hospital from January 2014 to August 2018. The diagnosis of IH was defined as loss of continuity of the fascia in the axial CT images. Results: 470 patients were included in the analysis. IH was diagnosed in 47 cases at 1 year after LC. The IH size was 7.8 cm2 [1.3–55.6]. In total, 38 patients with IH underwent CT examination 6 months after LC, and 37 were already diagnosed with IH. The IH size was 4.1 cm2 [0–58.9]. The IH size increased in 17 cases between 6 months and 1 year postoperatively, and in 1 case, a new IH occurred. 47%(18/38) of them continued to grow until 1 year after LC. A multivariate analysis was performed on the risk of IH occurrence. SSI was most significantly associated with IH occurrence (OR:5.28 [2.14–13.05], p = 0.0003). Conclusion: IH occurred in 10% and 7.9% at 1 year and 6 months after LC. By examining CT images taken for the postoperative surveillance of colorectal cancer, we were able to investigate the occurrence of IH in detail. [ABSTRACT FROM AUTHOR]

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Background: The risk of postoperative cognitive dysfunction(POCD) in laparoscopic surgery should not be overlooked. Intravenous lidocaine can reduce perioperative inflammatory response in patients undergoing laparoscopic surgery, while the effect of intraoperative intravenous lidocaine on postoperative cognitive function in patients undergoing laparoscopic colorectal cancer surgery has not been well studied. We investigated whether intraoperative lidocaine improves postoperative cognitive function after laparoscopic radical resection for colorectal cancer. Methods: We conducted a prospective, randomized double blinded controlled trial to investigate the effect of intravenous lidocaine on rapid postoperative recovery in patients undergoing laparoscopic radical resection of colorectal cancer. The patients were randomly assigned to receive either intravenous lidocaine or saline. The primary outcome was cognitive dysfunction defined by a decrease from pre- to postoperative ≥ 2 of the Mini-Mental State Examination (MMSE) score, at the 3rd and the 7th postoperative days. Secondary outcomes were the MMSE raw score and parameters of the patients' postoperative recovery such as agitation and length of stay in the post-anaesthesia care unit (PACU), length of hospital stay, markers of inflammation (white blood cell count and CRP), and incidence of complications. Results: Seventy-three patients in the lidocaine group and 77 patients in the control group completed the trial. The rate of cognitive dysfunction was lower in the lidocaine group than that in the control group, both at the 3rd (18.57% vs. 63.64% for each group respectively; RR = 0.26, 95%CI = 0.19–0.32; p < 0.0001) and at the 7th postoperative day (12.33% vs. 53.25% for each group respectively; RR = 0.28, 95%CI = 0.22–0.35; P < 0.001). The postoperative MMSE scores were also higher in the lidocaine group than in the control group both at the 3rd (median 25 vs. 24 respectively) and at the 7th postoperative day (26 vs. 24 respectively). Also, patients in the lidocaine group displayed a lower white blood cell count than the control group at the 1st postoperative day (8.5 ± 2.7 vs. 10.4 ± 3.3; p < 0. 001). No differences were evidenced for the other secondary outcomes. Conclusions: Intraoperative intravenous lidocaine can significantly improve postoperative cognitive function in patients undergoing laparoscopic radical resection of colorectal cancer. Trial registration: Chinese Clinical Trial Registry (16/1/2022, registration number: ChiCTR2200055683) [ABSTRACT FROM AUTHOR]

Several studies have recently reported the rare occurrence of internal herniation of the small bowel after laparoscopic colorectal surgery. Most cases of internal herniation after laparoscopic colorectal surgery occur due to a mesenteric defect. However, there have been no reports on the indications for closing mesenteric defects to prevent the development of an internal hernia. This study reports a case of an internal hernia of the proximal jejunum near the ligament of Treitz in a patient who underwent laparoscopic sigmoidectomy with splenic flexural mobilization and high ligation of the inferior mesenteric vein. Assessing the risk for internal herniation before completing the initial surgery is crucial. Additionally, mesenteric defect closure should be performed to prevent the development of internal hernias among patients with a potential risk. [ABSTRACT FROM AUTHOR]

Background : Laparoscopic surgery has become the golden standard for many procedures, requiring new skills and training methods. The aim of this review is to appraise literature on assessment methods for laparoscopic colorectal procedures and quantify these methods for implementation in surgical training. Materials and methods: PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched in October 2022 for studies reporting learning and assessment methods for laparoscopic colorectal surgery. Quality was scored using the Downs and Black checklist. Included articles were categorized in procedure-based assessment methods and non-procedure-based assessment methods. A second distinction was made between capability for formative and/or summative assessment. Results: In this systematic review, nineteen studies were included. These studies showed large heterogeneity despite categorization. Median quality score was 15 (range 0–26). Fourteen studies were categorized as procedure-based assessment methods (PBA), and five as non-procedure-based assessment methods. Three studies were applicable for summative assessment. Conclusions: The results show a considerable diversity in assessment methods with varying quality and suitability. To prevent a sprawl of assessment methods, we argue for selection and development of available high-quality assessment methods. A procedure-based structure combined with an objective assessment scale and possibility for summative assessment should be cornerstones. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This work was developed to compare the effects of transversus abdominis plane block (TAPB) and thoracic epidural anesthesia (TEA) mediated activation of inflammasome on postoperative medication, pain, and recovery in patients undergoing laparoscopic colorectal surgery. Then, the effects of two anesthesia methods on postoperative analgesia of patients were investigated and compared, aiming to provide reference for the selection of postoperative analgesia methods of laparoscopy. PATIENTS AND METHODS: In this work, patients undergoing laparoscopic colorectal surgery were rolled into a TAPB group (30 patients) and a TEA group (30 patients). The blood pressure and stress indexes of the patients at different time points were observed and compared, and the doses of anesthetic drugs were recorded. Postoperative pain scores were evaluated, and postoperative recovery of the two groups was compared. Meanwhile, the peripheral venous bloods were extracted from the two groups before and after surgery for the determination of inflammasome proteins, and the detection results were compared. RESULTS: Data showed that the dose of sufentanil in TEA group was notably inferior to that in TAPB group (p<0.05). The blood pressure indexes in the TEA group decreased remarkably (p<0.05), while their changes in the TAPB group were stable. The slower point heart rate (HR), lower mean arterial pressure (MAP), and lower levels of cortisol (Cor) and norepinephrine (NE) in the TEA group were found when compared with the TAPB group during the period from pneumoperitoneum establishment to post-ventilation. After pneumoperitoneum establishment, blood oxygen saturation (SpO2) in the TEA group was lower than that in the TAPB group at the same time point (p<0.05). The postoperative visual analog scales (VAS) score and numerical rating scale (NRS) score in TEA group were lower than those in TAPB group (p<0.05). After surgery, the protein level in TEA group was significantly lower than that in TAPB group (p<0.05). CONCLUSIONS: In short, the activation of inflammasome mediated by TEA could reduce the anesthetic agents used after laparoscopic colorectal cancer surgery and reduce the surgical stress response. In addition, TEA exerted a little effect on early immunity, which was safe and feasible, contributing to postoperative analgesia and recovery. In addition, its application value in laparoscopic postoperative analgesia was higher than TAPB. [ABSTRACT FROM AUTHOR]

Purpose This study was aimed to assess the feasibility of laparoscopic rectal surgery, comparing quality of surgical specimen, morbidity, and mortality. Methods Prospectively acquired data from consecutive patients undergoing laparoscopic surgery for rectal cancer, at 2 minimally invasive colorectal units, operated by the same team was included. Locally advanced rectal tumors were identified as T3B or T4 with preoperative magnetic resonance imaging scans. All the patients were operated on by the same team. The 1:1 propensity score matching was performed to create a perfect match in terms of tumor height. Results Total of 418 laparoscopic resections were performed, out of which 109 patients had locally advanced rectal cancer (LARC) and were propensity score matched with non-LARC (NLARC) patients. Median operation time was higher for the LARC group (270 minutes vs. 250 minutes, P=0.011). However, conversion to open surgery was done in 5 vs. 2 patients (P=0.445), reoperation in 8 vs. 7 (P=0.789), clinical anastomotic leak was found in 3 vs. 2 (P=0.670), and 30-day mortality rates was 2 vs. 1 (P>0.999) between LARC and NLARC, respectively. Readmission rate was higher in the NLARC group (33 patients vs. 19 patients, P=0.026), due to stoma-related issues. There was no statistically significant difference in the R0 resection between the 2 groups (99 patients in LARC vs. 104 patients in NLARC, P=0.284). Conclusion This study demonstrates that standardized approach to laparoscopy is safe and feasible in LARC. Comparable postoperative short-term clinical and pathological outcomes were seen between LARC and NLARC groups.

High intra-abdominal pressure (IAP) during laparoscopic surgery is associated with reduced splanchnic blood flow. It is uncertain whether a low IAP prevents this reduction. We assessed the effect of an individualized low-pneumoperitoneum-pressure strategy on liver perfusion. This was a single-center substudy of the multicenter 'Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy II study' (IPPCollapse–II), a randomized clinical trial in which patients received an individualized low-pneumoperitoneum strategy (IPP) or a standard pneumoperitoneum strategy (SPP). Liver perfusion was indirectly assessed by the indocyanine green plasma disappearance rate (ICG–PDR) and the secondary endpoint was ICG retention rate after 15 min (R15) using pulse spectrophotometry. Multivariable beta regression was used to assess the association between group assignment and ICG–PDR and ICG–R15. All 29 patients from the participating center were included. Median IAP was 8 (25th–75th percentile: 8–10) versus 12 (12,12) mmHg, in IPP and SPP patients, respectively (p < 0.001). ICG–PDR was higher (OR 1.42, 95%-CI 1.10–1.82; p = 0.006) and PDR–R15 was lower in IPP patients compared with SPP patients (OR 0.46, 95%-CI 0.29–0.73; p = 0.001). During laparoscopic colorectal surgery, an individualized low pneumoperitoneum may prevent a reduction in liver perfusion. [ABSTRACT FROM AUTHOR]

Background: Most of the studies published to date which assess the role of antibacterial sutures in surgical site infection (SSI) prevention include heterogeneous groups of patients, and it is therefore difficult to draw conclusions. The objective of the present study was to investigate whether the use of Triclosan-coated barbed sutures (TCBS) was associated with a lower incidence of incisional SSI and lower duration of hospital stay compared to standard sutures, in elective laparoscopic colorectal cancer surgery. Method: Observational including patients who underwent elective colorectal cancer laparoscopic surgery between January 2015 and December 2020. The patients were divided into two groups according to the suture used for fascial closure of the extraction incision, TCBS vs conventional non-coated sutures (CNCS), and the rate of SSI was analysed. The TCBS cases were matched to CNCS cases by propensity score matching to obtain comparable groups of patients. Results: 488 patients met the inclusion criteria. After adjusting the patients with the propensity score, two new groups of patients were generated: 143 TCBS cases versus 143 CNCS cases. Overall incisional SSI appeared in 16 (5.6%) of the patients with a significant difference between groups depending on the type of suture used, 9.8% in the group of CNCS and 1.4% in the group of TCBS (OR 0.239 (CI 95%: 0.065–0.880)). Hospital stay was significantly shorter in TCBS group than in CNCS, 5 vs 6 days (p < 0.001). Conclusion: TCBS was associated with a lower incidence of incisional SSI compared to standard sutures in a cohort of patients undergoing elective laparoscopic colorectal cancer surgery. [ABSTRACT FROM AUTHOR]

Background: Major abdominal surgery can cause significant post-operative pain and stress. Thoracic epidural analgesia (TEA) remains the gold-standard in its management. However, it is not without side effects or potential risks. Regional techniques might offer an alternative when thoracic epidural analgesia (TEA) is not possible. Aim of the Work: The aim of this study is to test the efficacy of ultrasound guided erector spinae plane block versus ultrasound guided oblique subcostal TAP block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used. Patients and Methods: In the current study, forty patients scheduled for elective laparoscopic colorectal surgery received general anaesthesia were included. Patients were divided randomly into two groups, each group includes 20 patients. Group T: Patients in this group received ultrasound guided OSTAP block after induction of general anaesthesia. Group E: Patients in this group received ultrasound guided ESP block after induction of general anaesthesia. Results: As regard the analgesic parameters recorded in the current study; the NRS was significantly lower in Group E (ESP) block when compared with that of Group T (OSTAP) block and showed significant difference between both groups at 4, 6, 8 and 10 hrs postoperatively. Time to rescue analgesia, there was clinically and statistically highly significant longer time to ist rescue analgesic in group E (ESP) block was 15.68þ1.50 hours compared to that of group T (OSTAP) block was 9.56þ2.41 hours. These findings were in an array with a case series done by Luis-Navarro and his colleagues who reported that the first rescue analgesic was required only at 16 hours after ESP block. In the current study, total meperidine consumption with the mean total consumption in each group was 75þ0.37mg in the ESP block group compared with 125þ0.87mg in the OSTAP block group there was highly statistically significant higher mean of total analgesic consumption in group T compared to group E. Conclusion: Erector spinae plane block under ultrasound guidance for laparoscopic colorectal surgery provides a longer duration and better quality of postoperative analgesia, as well as reducing the postoperative analgesic consumption when compared to oblique subcostal transversus abdominis plane block for laparoscopic colorectal surgery. Both blocks are mostly devoid of complications, and they provide reliable and effective postoperative analgesia in patients undergoing laparoscopic colorectal surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Mastery of technical skills is one of the fundamental goals of surgical training for novices. Meanwhile, performing laparoscopic procedures requires exceptional surgical skills compared to open surgery. However, it is often difficult for trainees to learn through observation and practice only. Virtual reality (VR)-based surgical simulation is expanding and rapidly advancing. A major obstacle for laparoscopic trainees is the difficulty of well-performed dissection. Therefore, we developed a new VR simulation system, Lap-PASS LP-100, which focuses on training to create proper tension on the tissue in laparoscopic sigmoid colectomy dissection. This study aimed to validate this new VR simulation system. Methods A total of 50 participants were asked to perform medial dissection of the meso-sigmoid colon on the VR simulator. Forty-four surgeons and six non-medical professionals working in the National Cancer Center Hospital East, Japan, were enrolled in this study. The surgeons were: laparoscopic surgery experts with > 100 laparoscopic surgeries (LS), 21 were novices with experience

Background: Laparoscopic colorectal surgery (LCRS) requires a small laparotomy at the umbilicus. The wound is small and inconspicuous, but if the patient develops an umbilical incisional hernia (UIH), the wound is visible and the patient suffers from symptoms of discomfort. However, the incidence of UIH after LCRS and its risk factors are not well understood. The purpose of this study was to investigate the risk factors for UIH after LCRS for colorectal cancer. Methods: This was a single‐centre retrospective study of 135 patients with colorectal cancer, conducted at our hospital from April 2013 to March 2019. The diagnosis of UIH was based on computed tomography and physical examination findings. Preoperative patient data such as enlargement of the umbilical orifice (EUO), subcutaneous fat thickness (SFT) and intraperitoneal thickness (IPT) were collected and analysed using univariate and multivariate analyses for the presence of risk factors for UIH. Results: A total of 135 patients who underwent LCRS were analysed. The incidence of UIH was 20.7%. Univariate analysis revealed significantly high body mass index (BMI) ≥ 25 (P = 0.032), EUO (P < 0.001), SFT ≥18 mm (P = 0.011), and IPT ≥61 mm (P < 0.01) in the UIH group. Multivariate analysis revealed significant differences in EUO (P < 0.001), SFT ≥18 mm (P = 0.046) and IPT ≥61 mm (P = 0.022). Conclusion: EUO was the most important risk factor for UIH, followed by IPT and SFT. These findings are predictive indicators of the development of UIH after LCRS and can be assessed objectively and easily with preoperative computed tomography. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic colorectal surgery has become a widely used method in many centers today. In our study, it was aimed to compare the postoperative clinical and oncological results in patients who underwent laparoscopic and open colorectal surgery and to compare them with the literature. Material and Method: The data of patients who underwent colorectal surgery between January 2012 and December 2018 at the Dışkapı Yıldırım Beyazıt Training and Research Hospital General Surgery clinic were analyzed retrospectively. Results: A total of 544 patients were included in our study, of which 438 (80.5%) underwent open resection, 73 (13.4%) laparoscopic, 33 (6.1%) underwent resection with conversion. In the series, the number of cases that were operated urgently was 158 (29.0%), and the number of elective cases was 386 (71.0%). A total of 156 (28.7%) postoperative complications were detected. When evaluated according to the groups; There were 20 (27.4%) postoperative complications in the laparoscopic surgery group, 126 (28.8%) in the open surgery group, and 10 (30.3%) in the conversion group. The mean number of lymph nodes removed in rectal cancers is 19.0±9.7 in the open procedure and 22.3±11.6 in the laparoscopic procedure (p: 0.198). A positive circumferential surgical margin was found in 1 (2.3%) and 8 (5.9%) patients with rectal cancer in the laparoscopic and open surgery groups, respectively (p: 0.456). The mean distal surgical margin was 45.1±39.8 mm in the open group and 41.1±37.7 mm in the laparoscopic group (p: 0.608). Conclusion: Laparoscopic colorectal cancer surgery has comparable clinical and oncological outcomes to the open procedure. Given the many known advantages of minimally invasive surgery, laparoscopic surgery will likely become the standard treatment for colon cancer. [ABSTRACT FROM AUTHOR]

Background/aim: Owing to underlying diseases and decreased physiological functions, frailty in elderly patients may be associated with adverse postoperative complications and mortality. To date, there are various frailty assessment methods, with the five-item modified frailty index (mFI-5) being an objective and concise evaluation tool. This study aimed to clarify whether mFI-5 scoring, a measure of frailty, can predict postoperative outcomes in elderly patients undergoing laparoscopic colorectal surgery., Patients and Methods: A total of 107 patients aged over 80 years who underwent laparoscopic colorectal surgery at Nagasaki University Hospital between 2011 and 2018 were included in this study. The mFI-5 was used to assess the preoperative condition of each patient, with scores compared against various postoperative outcome measures. Univariate analysis was used to determine between-group differences for pre- and post-operative variables., Results: Of the 107 patients [median age, 83 (80-99) years], 44.9% were male. The mFI-5 score was calculated and patients were divided into three groups: 0 (n=36, 33.6%); 1 (n=44, 41.1%); and 2+ (n=27, 25.3%). The groups were significantly associated with the American Society of Anesthesiology (ASA) classification (p<0.001). Postoperative complications occurred in 43 patients (40.2%), and a higher mFI-5 score was significantly associated with postoperative complications of Clavien-Dindo grade ≥III and duration of hospital stay., Conclusion: The mFI-5 is an objective and useful tool for predicting postoperative complications of laparoscopic surgery in elderly patients with colorectal cancer., Competing Interests: The Authors have no conflicts of interest to declare in relation to this study., (©2024 The Author(s). Published by the International Institute of Anticancer Research.)

Minimally invasive surgery has transformed the management of complex procedures, offering reduced postoperative pain, faster recovery time, and improved cosmetic outcomes. Despite the growing use of minimally invasive techniques, literature specifically addressing single-incision laparoscopic surgery (SILS) for combined hemicolectomy and cholecystectomy is limited. This report seeks to fill this gap by detailing the successful management of a patient case through a single-incision combined laparoscopic right hemicolectomy and cholecystectomy. A 66-year-old female was referred to surgical consultation following a routine screening colonoscopy that identified a greater than 5 cm sessile polyp in the ascending colon. A follow-up computed tomography (CT) scan of the abdomen and pelvis revealed a non-metastatic mass in the ascending colon and gallstones correlating with the patient's reported abdominal discomfort. The decision was made to proceed with a single-incision laparoscopic right hemicolectomy and cholecystectomy. The cholecystectomy and subsequent right hemicolectomy were both performed through a 3 cm umbilical incision using the advanced access platform. Postoperative recovery was uneventful, with the patient passing flatus by day three, starting a clear liquid diet, and being discharged by day four. Pathological analysis of specimens revealed chronic cholecystitis with cholelithiasis and a tubulovillous adenoma of the colon without high-grade dysplasia or metastatic carcinoma. At the 15-day follow-up, the patient reported a full resumption of normal activities and was highly satisfied with the cosmetic results. This case report highlights the benefits of combining SILS right hemicolectomy and cholecystectomy through reducing multiple abdominal procedures, surgical trauma, operating time, and recovery period, all while achieving excellent cosmetic outcomes. Further research and advanced training in SILS combined procedures are needed for broader applicability in more complex cases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ansari et al.)

Indocyanine green (ICG) fluorescence is an emerging technique in the surgical field. Among its various applications, it allows surgeons to have real-time visualization of the lymphatic drainage of an organ. The primary outcome of our study is the feasibility and safety of ICG-guided colorectal surgery. Our secondary outcome is the efficacy of ICG-guided lymphadenectomy and whether or not ICG positivity correlates with the identification of nodal metastasis. We conducted a single-center prospective study including 32 patients who underwent surgery for colorectal cancer. For each case, ICG was injected into the tumor area either prior to or during surgery. Tumor specimens and excised lymph nodes were analyzed using hematoxylin and eosin (H&E) staining. In all patients, ICG injected in the tumor area allowed clear visualization of the lymphatic drainage. A total of 499 lymph nodes were collected, with a mean of 16 per patient. Fifty ICG positive lymph nodes outside the standard lymphadenectomy zone were examined; however, none of the nodes showed signs of nodal metastasis. ICG-guided colorectal surgery is safe, feasible and easily reproducible, with a relatively low cost and no radiation exposure. ICG can help the surgeon to visualize the anatomical structures. We did not find an oncological diagnostic advantage in the use of ICG-guided nodal navigation. [ABSTRACT FROM AUTHOR]

Background: As one of the 12 clinical pathways of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program, the Colorectal Pathway intends to deliver didactic content organized along 3 levels of performance (competency, proficiency and mastery) each represented by an anchoring procedure (laparoscopic right colectomy, laparoscopic left/sigmoid colectomy, and intracorporeal anastomosis during minimally invasive (MIS) ileocecal or right colon resection). In this article, the SAGES Colorectal Task Force presents focused summaries of the top 10 seminal articles selected for laparoscopic right colectomy which surgeons should be familiar with. Methods: Using a systematic literature search of Web of Science, the most cited articles on laparoscopic right colectomy were identified, reviewed, and ranked by the SAGES Colorectal Task Force and invited subject experts. Additional articles not identified in the literature search were included if deemed impactful by expert consensus. The top 10 ranked articles were then summarized, with emphasis on relevance and impact in the field, findings, strengths and limitations, and conclusions. Results: The top 10 seminal articles selected for the laparoscopic right colectomy anchoring procedure include articles on surgical techniques for benign and malignant disease, with anatomical and video illustrations, comparative outcomes of laparoscopic vs open colectomy, variations in technique with impact on clinical outcomes, and assessment of the learning curve. Conclusions: The top 10 seminal articles selected for laparoscopic right colectomy illustrate the diversity both in content and format of the educational curriculum of the SAGES Masters Program to support practicing surgeon progression to mastery within the Colorectal Pathway. [ABSTRACT FROM AUTHOR]

Abstract Background Robot-assisted surgery is increasingly implemented for the resection of colorectal cancer, although the scientific evidence for adopting this technique is still limited. This study’s main objective was to compare short-term complication rates, oncological outcomes, and the inflammatory stress response after colorectal resection for cancer performed laparoscopic or robot-assisted. Methods We conducted a retrospective cohort study comparing the robot-assisted approach to laparoscopic surgery for elective malignant colorectal neoplasm. Certified colorectal and da Vinci ® robotic surgeons performed resections at a Danish tertiary colorectal high volume center from May 2017 to March 2019. We analyzed the two surgical groups using uni- and multivariate regression analyses to detect differences in intra- and postoperative clinical outcomes and the inflammatory stress response. Results Two hundred and ninety-eight patients were enrolled in the study. Significant differences favoring robot-assisted surgery was demonstrated for; length of hospital stay (4 days, interquartile range (4, 5) versus 5 days, interquartile range (4–7), p < 0.001), and intraoperative blood loss (50 mL, interquartile range (20–100) versus 100 mL, interquartile range (50–150), p < 0.001) compared to laparoscopic surgery. The inflammatory stress response was significantly higher after laparoscopic compared to robot-assisted surgery reflected by an increase in C-reactive protein concentration (exponentiated coefficient = 1.23, 95% confidence interval (1.06–1.46), p = 0.008). No differences between the two groups were found concerning mortality, microradical resection rate, conversion to open surgery, and surgical or medical short-term complication rates. Conclusion Robot-assisted surgery is feasible and can be safely implemented for colorectal resections. The robot-assisted approach, when compared to laparoscopic surgery, was associated with improved intra- and postoperative outcomes. Extensive prospective studies are needed to determine the short- and long-term outcomes of robotic surgery for colorectal cancer.

Background: It has been reported that in conventional open surgery, approximately 10% of surgical gloves are perforated during surgery without being noticed. To protect both the patient and medical staff from harm, double gloving or changing gloves routinely at certain intervals during surgery is recommended. However, whether these protective measures are also necessary for laparoscopic colorectal surgery is unknown because the actual perforation rate during laparoscopic procedures is unclear. Methods: Seventy-seven laparoscopic colorectal surgeries were evaluated, and a total of 616 surgical gloves used in the surgeries were collected for analysis. The presence of glove perforation was tested by the standard water-leak test method (EN455-1). Results: Seven perforations were detected (1.1%). The duration of the laparoscopic procedure was not a statistically significant risk factor for glove perforation (p = 0.41). Postoperative surgical site infections (SSIs) were observed in 12 cases (15.6%), but there was no significant correlation between the presence of glove perforation and SSI (p = 0.92). According to the bacterial cultivation results, the majority of causative agents of SSI were enterobacteria, which belong to the major gut flora. Conclusion: Although the perforation rate was considerably lower than that in open surgery, surgical glove perforation occurred during laparoscopic procedures. Double gloving in laparoscopic colorectal surgery is recommended not to prevent SSI but to protect medical workers from harmful infections after direct contact with the patient. [ABSTRACT FROM AUTHOR]

Introduction: The incidence and clinical significance of postoperative urinary retention (POUR) remain high. This study aimed to evaluate the incidence of POUR and related risk factors in patients who underwent total mesorectal excision (TMR) for low rectal cancer. Methods: This study is a retrospective review of a prospectively collected colorectal database from a single center. Data from patients who underwent surgery for low rectal cancer between September 2006 and May 2017 were analyzed to assess the risk factors of POUR. POUR was considered inability to void after urinary catheter removal requiring catheter reinsertion and difficulty in bladder emptying requiring intermittent catheterization. Results: Of 555 patients with low rectal cancer, 78 (14.1%) developed POUR. Based on multivariate logistic regression analysis, laparoscopic TMR (odds ratio [OR]; 2.114, 95% confidence interval [CI]; 1.212–3.689, p = 0.008) and postoperative ileus (OR; 2.389, 95% CI; 1.282–4.450, p = 0.006) were independent risk factors of POUR. Male gender, advanced age, neoadjuvant chemoradiation, longer operative time, abdominoperineal resection, and lateral pelvic lymph node dissection were not associated with POUR. Advanced age over 65 years also failed to show statistical significance (OR; 1.604, 95% CI; 0.965–2.668, p = 0.068). Conclusion: Laparoscopic approach and postoperative ileus are risk factors for POUR after low rectal cancer surgery. We postulate that the benefits of robotic surgical systems compared to a laparoscopic approach may reduce the incidence of POUR. [ABSTRACT FROM AUTHOR]

Background & Objective: Post-operative nausea and vomiting is one of the major problems faced by the anesthesiologists in patients recovering from anesthesia and surgery. A variety of antiemetics have need tried to prevent and control it with variable success. Traditional Chinese Medicine advocates stimulation of P-6, or Neiguan, acupressure point. The aim of this study was to compare the efficacy of intravenous ondansetron with P-6 acupressure stimulation in prevention of post-operative nausea and vomiting after elective laparoscopic colorectal surgery. Methodology: After approval from the Scientific Review Committee (SRC) and Institutional Review Board (IRB), 80 patients of ASA II and III, aged 18 to 60 y, planned for elective laparoscopic colorectal surgery under general anesthesia were randomly allocated into two groups by the lottery method. Group A (n = 40) received inj. ondansetron 0.15 mg/kg IV and in Group B (n = 40) acupressure was applied on pressure point P-6. Both groups received IV dexamethasone 0.15 mg/kg intraoperatively. Balanced general anesthesia was given and intraoperative vitals were recorded at regular intervals. The incidence and severity of nausea and vomiting was recorded during first 24 h postoperatively. Results: No significant difference in the number of patients having nausea and vomiting or the severity of vomiting during 24 h post-operative period was found between the two groups (p > 0.05). Conclusion: In this study we did not find a statistically significant difference between P-6 acupressure stimulation and intravenous ondansetron in the prevention of post-operative nausea and vomiting after elective laparoscopic colorectal surgery. [ABSTRACT FROM AUTHOR]

Iatrogenic ureteral injury is an uncommon but severe complication of laparoscopic colorectal surgery. If it is detected intraoperatively, conversion to open surgery is usually inevitable. Here, we described a complete ureteral transection during laparoscopic low anterior resection, which was simultaneously repaired by laparoscopic uretero-ureterostomy. The most important points during the anastomosis of two tiny tubular tissues are dissecting the tubular organs without trauma, obtaining meticulous hemostasis without causing any necrosis, and achieving accurate approximation of tissues with the sutures. To the best of our knowledge, this is the first report that focused on laparoscopic repair of ureteral injury during laparoscopic colorectal surgery. As there are still few data on laparoscopic repair of ureteral lesions, no firm conclusions can be drawn. But, in appropriate cases, if intracorporeal suture expertise is available, laparoscopic repair can be done during colorectal surgery.

Objective: Laparoscopic surgery is an alternative procedure for colorectal cancers. However, high-level supporting evidence has been derived from high-volume centers in developed countries. During the early phase of applying the laparoscopic approach, we evaluated the procedure’s short-term outcomes in our regional middle-volume hospital in a developing country. Methods: We retrospectively analyzed data for a cohort of 223 colorectal cancer patients who underwent elective surgery from October 2017 to September 2019. We compared 165 patients undergoing open surgery (OS group) with 58 undergoing laparoscopic surgery (LS group) using a propensity score-matched analysis. Results: After matching, each group contained 58 patients for evaluating outcomes. The LS group had more harvested mesenteric lymph nodes (5.0 nodes, 95% confidence interval (CI): 1.8–8.1; p-value:

Objectives: Incisional hernia is a common problem after colorectal surgery, and a laparoscopic approach does not reduce the incisional hernia rate. Previous reports have described the risk factors for incisional hernia; however, the impact of suture materials remains unclear. As such, this study compared the incisional hernia rate using different suture materials for abdominal wall closure after laparoscopic colorectal cancer surgery. Methods: Patients undergoing laparoscopic colorectal cancer surgery between January 2014 and December 2016 were included in this study. We separated patients into the following two groups based on the suture materials used for abdominal wall closure: (1.) fast-absorbable group and (2.) non-absorbable group. The primary outcome was incisional hernia rate that was diagnosed using computed tomography. We compared outcomes between these two groups using propensity score matching. Results: Before matching, 394 patients were included (168 in the fast-absorbable group and 226 in the non-absorbable group). After one-to-one matching, patients were stratified into the fast-absorbable group (n = 158) and the non-absorbable group (n = 158). The incisional hernia rate was higher in the fast-absorbable group than in the non-absorbable group (13.9% vs. 6.3%; P = 0.04). The median time to develop an incisional hernia was significantly shorter in the fast-absorbable group (6.7 months vs. 12.3 months; P < 0.01). The incidence of surgical site infection was not different between the two groups, but the incidence of suture sinus was lower in the fast-absorbable group (0% vs. 5.1%; P < 0.01). Conclusions: The use of fast-absorbable sutures may increase the risk of incisional hernia after laparoscopic colorectal cancer surgery.

Introduction: The development of laparoscopic colorectal surgery began in 1991. Today, laparoscopic surgery presents standard approach in the surgical treatment of malignant colon and rectal diseases. Aim: Surgical and oncological outcomes and survival rates of laparoscopic colorectal surgery at the Oncology Institute of Vojvodina. Methods: Data were collected prospectively from 66 patients undergoing laparoscopic colorectal surgery between December 2009 and December 2019. Registered data included sex, age, surgical indication and type for the procedure, indication and reason for conversion to open surgery, operative time, performing temporary or permanent stoma, intraoperative bowel perforation, pathologic TNM grade, number of harvested lymph nodes, inclusion of positive resection margin, number of postoperative days at the hospital, postoperative complications, postoperative mortality, presence of distant metastases and survival rates. Results: Laparoscopic procedures were right hemicolectomy in 11/66 (16.7%), left hemicolectomy in 1/66 (1.5%), sigmoid colectomy in 19/66 (28.8%), high anterior rectal resection in 13/66 (19.7%), low anterior rectal resection in 12/66 (18.2%), abdominoperineal amputation of the rectum in 7/66 (10.6%), colectomy in 2/66 (3%) and proctocolectomy in 1/66 (1.5%) patient. The median follow-up was 37.5 months (range 6 to 128). The total number of surviving patients was 60 (90.9%). Conclusion: This study showed that laparoscopic colorectal surgery has good clinical and oncological outcomes.

Introduction/Objective. The aim of our study was to compare early postoperative recovery in patients operated on using laparoscopically assisted and open method in colorectal carcinoma surgery. Methods. The study involved 60 patients, divided into two groups of 30 patients each, treated with open or laparoscopically assisted colorectal surgery. Three groups of factors were collected and analyzed for all the patients. The first group of factors were as follows: age, sex, the American Society of Anesthesiologists score, preoperative hemoglobin, localization. The second group of factors were the following: intraoperative complications, the duration of operations, blood and blood derivatives’ compensation. The third group were as follows: complications, length of stay in intensive care, rate of peristaltic establishment, and the time needed for unobstructed oral intake, number of hospitalization days, analgesic use, and verticalization time. Results. The patients who underwent laparoscopically assisted surgery showed significant advantages in the early postoperative recovery compared with those who underwent open surgery, in terms of the number of postoperative days of hospitalization (p < 0.001), the duration of the operation (p < 0.001), the day of establishment of peristalsis (p = 0.009), and the day of establishment of unobstructed oral intake (p < 0.001), the time of verticalization of the patients (p = 0.001), the use of analgesics (p < 0.001). Conclusion. Laparoscopically assisted surgery has an advantage over open surgery colorectal cancer, as regards of early postoperative recovery of the patient.

Background: Mastery of technical skills is one of the fundamental goals of surgical training for novices. Meanwhile, performing laparoscopic procedures requires exceptional surgical skills compared to open surgery. However, it is often difficult for trainees to learn through observation and practice only. Virtual reality (VR)-based surgical simulation is expanding and rapidly advancing. A major obstacle for laparoscopic trainees is the difficulty of well-performed dissection. Therefore, we developed a new VR simulation system, Lap-PASS LP-100, which focuses on training to create proper tension on the tissue in laparoscopic sigmoid colectomy dissection. This study aimed to validate this new VR simulation system.Methods: A total of 50 participants were asked to perform medial dissection of the meso-sigmoid colon on the VR simulator. Forty-four surgeons and six non-medical professionals working in the National Cancer Center Hospital East, Japan, were enrolled in this study. The surgeons were: laparoscopic surgery experts with > 100 laparoscopic surgeries (LS), 21 were novices with experience < 100 LS, and five without previous experience in LS. The participants' surgical performance was evaluated by three blinded raters using Global Operative Assessment of Laparoscopic Skills (GOALS).Results: There were significant differences (P-values < 0.044) in all GOALS items between the non-medical professionals and surgeons. The experts were significantly superior to the novices in one item of GOALS: efficiency ([4(4-5) vs. 4(3-4)], with a 95% confidence interval, p = 0.042). However, both bimanual dexterity and total score in the experts were not statistically different but tended to be higher than in the novices.Conclusions: Our study demonstrated a full validation of our new system. This could detect the surgeons' ability to perform surgical dissection and suggest that this VR simulator could be an effective training tool. This surgical VR simulator might have tremendous potential to enhance training for surgeons. [ABSTRACT FROM AUTHOR]

Aim: To compare three approaches (laparoscopic, open, and conversion of laparoscopic approach) for the management of intra-abdominal surgical complications after elective laparoscopic colorectal surgery. Materials and Method: This was a retrospective cohort study including patients who required reoperation due to an intra-abdominal surgical complication after initial elective laparoscopic colorectal surgery. Patients were grouped according to the reoperation approach-laparoscopic reoperation, laparoscopic reoperation that required conversion to open surgery, and open reoperation. Pre-operative variables (age, gender, ASA score, BMI, comorbidities, and surgical history), operative variables (cause of reoperation, latency for reoperation, operative time, surgery performed, and cause of conversion), and post-operative variables (intestinal transit, hospital days, ICU days, medical complications, surgical site infection, evisceration, transfusion and 30-day mortality), were compared between groups. Results: There were no significant differences between groups among the pre-operative and operative variables. In terms of post-operative variables, the laparoscopic reoperation group, had fewer hospital days (p = 0.012), fewer ICU days (p = 0.001), and faster intestinal transit regarding gas, stool and return to solid diet (p = 0.008, p = 0.029 and p = 0.030, respectively). However, there were no significant differences in surgical site infection, evisceration, medical complications, transfusion, and mortality. Discussion and Conclusion: This study revealed better post-operative clinical course in the laparoscopic reoperation group, with shorter hospital and ICU stay, and reduced postoperative ileus, without increased morbidity or mortality. Laparoscopic reoperation for complications after elective laparoscopic colorectal surgery may therefore be the preferred approach. [ABSTRACT FROM AUTHOR]

Aim:The laparoscopic approach in colorectal surgery is widely applied in experienced centers. In this study, we aimed to present the short-term results of our first laparoscopic experience on the patients with primary diagnosis of colorectal cancer (CRC) in our newly opened hospital.Method:Between 10 August 2018-1 November 2019, patients who underwent elective laparoscopic surgery with the primary diagnosis of CRC in the Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Clinic of General Surgery were included in the study. Demographic characteristics, type of surgery, duration of surgery, pathology results, length of hospitalization, first bowel movements time, oral intake starting days, drainage catheter removal time, rate of conversion to open surgery, complications and early mortality were evaluated.Results:A total of 20 patients (11 male, 9 female) were included in the study. The median age was 60 (41-80) years. The most performed operation was the right hemicolectomy (50%). In 3 (15%) patients laparoscopic surgery was converted to open surgery. Three (15%) patients developed wound infection, hematoma was seen in 1 (5%) patient, and 1 patient (5%) developed ileus. The mean operative time was 172±31 min and the duration of hospitalization was 7 days (5-15). The total number of dissected lymph nodes was higher in female patients (p=0.02). There was a positive correlation between operation time and length of hospitalization (p=0.016, r=0.532), and tumor diameter and oral intake time (p=0.03, r=0.621). There was no anastomotic leakage or early mortality.Conclusion:Especially our rate of conversion to open surgery, complications, and oncologic outcomes were in line with the literature.

Abstract Background A transomental hernia is defined as bowel invagination into an abnormal hiatus of the omentum. It is a rare type of internal hernia that is sometimes lethal. We herein report a case of a transomental hernia developing shortly after laparoscopic sigmoidectomy. Case presentation A 71-year-old man underwent laparoscopic sigmoidectomy. He was admitted to our hospital because of abdominal pain and nausea on postoperative day 12. Laboratory investigation showed increased levels of inflammatory markers. Abdominal computed tomography showed a closed loop and mesenteric edema of the small intestine with ascites. We performed an emergency operation under the diagnosis of strangulated bowel obstruction. Operative findings showed internal herniation of strangulated ileal loops through a defect of the omentum with hemorrhagic ascites. The incarcerated small bowel was resected and reconstructed because the ischemic change was irreversible after the reduction. We partially resected the omentum that had formed the defect. The patient’s postoperative progress was good, and he was discharged on postoperative day 8. Conclusions Almost all internal hernias after intestinal surgery are mesenteric hernias; however, we should bear in mind that the more lethal transomental hernia is also possible. Therefore, immediate surgical exploration should be performed in a timely manner for internal hernias, especially for patients with early-onset symptoms after laparoscopic intestinal surgery.

High intra-abdominal pressure (IAP) during laparoscopic surgery is associated with reduced splanchnic blood flow. It is uncertain whether a low IAP prevents this reduction. We assessed the effect of an individualized low-pneumoperitoneum-pressure strategy on liver perfusion. This was a single-center substudy of the multicenter ‘Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy II study’ (IPPCollapse–II), a randomized clinical trial in which patients received an individualized low-pneumoperitoneum strategy (IPP) or a standard pneumoperitoneum strategy (SPP). Liver perfusion was indirectly assessed by the indocyanine green plasma disappearance rate (ICG–PDR) and the secondary endpoint was ICG retention rate after 15 min (R15) using pulse spectrophotometry. Multivariable beta regression was used to assess the association between group assignment and ICG–PDR and ICG–R15. All 29 patients from the participating center were included. Median IAP was 8 (25th–75th percentile: 8–10) versus 12 (12,12) mmHg, in IPP and SPP patients, respectively (p < 0.001). ICG–PDR was higher (OR 1.42, 95%-CI 1.10–1.82; p = 0.006) and PDR–R15 was lower in IPP patients compared with SPP patients (OR 0.46, 95%-CI 0.29–0.73; p = 0.001). During laparoscopic colorectal surgery, an individualized low pneumoperitoneum may prevent a reduction in liver perfusion.

Background & Objective: Colorectal cancer is the third most common cancer in both men and women in Thailand and around the world. Laparoscopic colectomy (LC) has gained wide acceptance as a curative procedure for colorectal cancer treatment. However, in Thailand, LC is practiced in high-volume hospitals. A predisposing factor for a higher morbidity rate of LC was male gender. The primary aim of this retrospective study was to review the clinical and short-term oncological outcomes of laparoscopic colectomy for colorectal cancer from the preliminary first-hand experience of a general surgeon performing LC at Trang Hospital. The secondary aim was to test the hypothesis that male gender has no impact on the clinical and short-term oncological outcomes. Patients and Methods: A retrospective study was conducted at Trang hospital in all colorectal cancer patients who underwent laparoscopic colorectal surgery between August 2017 and December 2019. Patient characteristics, perioperative, pathologic and short-term oncological outcomes were reported and compared between the genders. Results: In 19 colorectal cancer patients who underwent laparoscopic colorectal resection, there was a significant difference in tumor size between the men and women (p = 0.049) but no differences in perioperative outcomes between the two genders (p > 0.05). The overall conversion rate was 26%, the intraoperative complication rate was 5% and the postoperative complication rate was 16%. The mean follow-up period was 29 ± 11 months. There were no differences in the disease-free survival (DFS) (67% vs. 90%; p = 0.224) and overall survival (OS) (78% vs. 100%; p = 0.125) between men and women. The 2-year DFS and OS of all patients were 83% and 89%, respectively. Conclusion: General surgeons can perform laparoscopic colorectal resection effectively and safely with acceptable outcomes. Male gender has no impact on the outcomes of laparoscopic colorectal resection in patients with colorectal cancer. [ABSTRACT FROM AUTHOR]

Background: Although enhanced recovery after surgery (ERAS) has been proven to be beneficial after laparoscopic colorectal surgery, some of the patients may fail to complete the ERAS program during hospitalization. This prospective study aims to evaluate the risk factors associated with ERAS failure after laparoscopic colorectal cancer surgery.Methods: This is a prospective study from a single tertiary referral hospital. Patients diagnosed with colorectal cancer who met the inclusion criteria were included in this study. Demographic and clinicopathological characteristics were collected. Post-operative activity time and 6-min walking distance (6MWD) were measured. Patients were divided into ERAS failure group and ERAS success according to decreased post-operative activity and 6MWD. Factors associated with ERAS failure were investigated by univariate and multivariate analysis.Results: A total of 91 patients with colorectal cancer were included. The incidence of ERAS failure is 28.6% among all patients. Patients in ERAS failure group experienced higher rate of post-operative ileus and prolonged hospital stay (p < 0.001). Multivariate analysis revealed that older age (p = 0.006), body mass index ≥25.5 kg/m2 (p = 0.037), smoking (p = 0.002), operative time (p = 0.048), and post-operative energy intake