Laparoscopic colorectal surgery--new advances and techniques.
Laparoscopic colorectal surgery is being assessed in many centres worldwide. This paper looks at the authors' experiences of 320 laparoscopic colorectal procedures and discusses modifications of technique, new instruments and changes in outcomes as experience is attained. Operating times are now approaching that of open surgery as the "learning curve" levels out. For example, the median operating time for the last 20 patients undergoing a laparoscopic right hemicolectomy was 2.1 hours and anterior resection was 2.2 hours. Of the 320 laparoscopic colorectal procedures performed, the conversion rate of 8.1% (26 patients) and perioperative death rate of 2.2% (7 patients) appear to be acceptable for the extent of surgery performed. The median inpatient stay for the last 20 patients undergoing a laparoscopic-assisted right hemicolectomy or high anterior resection was 5 days (range 3 to 11 days) and 4 days (range 3 to 18 days) respectively. Outcomes for cancer patients are encouraging. Of 106 selected patients having a potentially curative resection for colorectal and anal cancer, there have been 10 recurrences (9.4%) to date. Sixty-four patients have now been followed-up for more than 2 years. It is our belief that with appropriate patient selection a laparoscopic approach can give outcomes similar to open surgery with a slightly decreased hospital stay and convalescence. Laparoscopic colorectal surgery, particularly for benign disease, should be encouraged.
Stitz
R W
RW
Department of Surgery, Royal Brisbane Hospital, Australia.
Lumley
J W
JW
D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000175:diagnosis / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods; D008297:Male; D013677:Medical Laboratory Science / Q000639:trends; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000503:physiopathology*; D012002:Rectal Diseases / Q000175:diagnosis / Q000601:surgery; D012016:Reference Values