Feasibility Of Laparoscopic Colorectal Surgery
To describe the experience of the laparoscopic approach in colorectal surgery in a tertiary care center over a period of 4 years. Considering the evaluation of the results in the short and medium terms, in the different scenarios of colorectal pathology. Lap trainer box.
Laparoscopic Training model with Lap Trainer Box is a sensible choice.
Material And Methods
A retrospective review of cases undergoing laparoscopic colorectal surgery in the period from June 2003 to July 2007 carry out. Evaluating the operative and postoperative results, as well as morbidity and mortality for benign and malignant procedures.
Surgical time in cases of benign disease was 125 minutes. Regarding the item of operative time, a systematic review shows the mean operative time in 178 minutes for the open group against 152 minutes in the laparoscopic group (p < 0.001).
Trans Operative Bleeding
The mean trans operative bleeding in our group of benign diseases was 110 mL, this is slightly lower than that found in the literature with a mean of 158 mL for the laparoscopic group versus 298 mL for the open group (p < 0.001).
Tolerance To the Oral Route
In relation to the time of tolerance to the oral route, the average was 3.1 days, which is practically equal to the average time for tolerance to the oral route of the laparoscopic cases against 4.6 days for the open group (p < 0.001). That is, in general, faster recovery times of gastrointestinal function reports by 25 to 35% when minimally invasive surgery uses compared to the open approach. Lap trainer box.
Mean Hospital Stay
Our mean hospital stay is 4.1 days for benign disease and 5.1 days for malignant disease, lower than that found in a systematic review that shows a mean of 7.8 days for the laparoscopic group versus 11.6 days.
Retrospective Article Analyzes to Colorectal Pathology
Although this series of cases represents the largest, there are weaknesses of this study to consider. Such as the fact that this is a retrospective article and where the experience of laparoscopic surgery in colorectal pathology analyzes in general. Where they involve many pathologies, and therefore of procedures. Caution exercises in generalizing the results. It is also important to note that this sample not compares against the different open procedures. That is, it not compares against the laparoscopy.
Progress Of Method
The progress of this type of method is rising slowly, and therefore, many of our stated sequence are of a small quantity of cases. This reflects the reality of our country, since to our knowledge this is the largest series of cases in our country. Lap trainer box.
Development Of Minimally Invasive Surgery
Therefore, we note that the current level of development of minimally invasive colorectal surgery is that of feasibility and safety to perform the different procedures found in the literature. Understanding this, we must also seek to comply with the appropriate surgical principles in each of the pathologies.
Always critically evaluating the short and long-term results. Both in benign and malignant pathology, even if it is a series small of cases.
Percentage Of Complications
The total percentage of complications is less than 13% in our series and a mortality rate of less than 1%. Confirming that this technique is safe when an adequate selection makes of the cases that performs by minimal invasion. This is of vital importance for the groups that are starting their experience. Since where the balance tilt in relation to cost-benefit of each of the surgical approaches. For the resolution of the different colorectal pathologies. Lap trainer box.
Feasibility Of Laparoscopic Surgery
This series demonstrates the feasibility of performing laparoscopic surgery. Both colon and rectum in both scenarios benign and malignant disease. This is undoubtedly the largest series in the country and although it is not a comparative study.
In the evaluated period, 170 laparoscopic colorectal procedures perform, of which 52 (30%) are for malignant disease and 118 for benign disease 70%, the most frequent indication was diverticular disease, followed by colon cancer and the most performed procedure was sigmoidoscopy. Lap trainer box.
Followed by right hemicolectomy. The overall rate of complications was 12%. And the mortality amount was less than 1%. The conversion rate was 8.8% (15 patients). In relation to the oncological results, the mean follow-up is 2 years, with a recurrence rate of 6%. In the 52 cases negative surgical margins obtains and the mean number of nodes in the surgical specimen was 15.69 (± 3.53).
It is It sees that compared to other series published in the literature. The complication rate is acceptable both in minor complications and in major morbidity. In the same way, the mortality rate of 0.6% is acceptable. Lap trainer box.
We recommend that if the volume of patients is sufficient to complete the learning curve. And the appropriate surgical and instrumental training requirements meets. There is no reason minimally invasive surgery does not perform, if compare results obtained with what exists in the literature.
The laparoscopic approach to colorectal pathology is safe and feasible in experienced centers. with results comparable to those reported in the literature for the open approach. In this series, it is not yet feasible to draw firm conclusions on the results obtained in malignant disease, so the patients follow up long-term.
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