The contributions of virtual colonoscopy to laparoscopic colorectal surgery.
OBJECTIVE
Operative tumor or polypectomy site localization and synchronous colonic lesions are challenging problems especially in laparoscopic surgery. We designed this prospective study to determine the contributions of virtual colonoscopy to laparoscopic colorectal surgery.


METHODS
Virtual colonoscopy was performed in 40 consecutive patients who had undergone laparoscopic resection for colorectal neoplasm. Preoperative findings of optical colonoscopy and virtual colonoscopy, operative data, tumor localizations and histopathologic findings were assessed.


RESULTS
Accuracy rates for virtual colonoscopy and optical colonoscopy were 97.5% and 55%, respectively (P<0.05). Polypectomy site was localized with virtual colonoscopy in five patients. There were nine partially obstructing tumors that did not allow optical endoscope passage. Four of six synchronous tumors (one tumor and three polyps) couldn't be shown with optical colonoscopy because of distal obstructing tumor. Histopathologic investigations revealed adenocarcinoma (n=34), adenoma demonstrating low-grade dysplasia (n=3) and high-grade dysplasia (n=2) and neuroendocrine carcinoma (n=1). Mean tumor size was 4 (1.5-10) cm. Mean proximal and distal surgical margins were 15 (5-36) cm and 7.3 (0.8-27) cm, respectively. Overall patient preference was 87.5% for virtual colonoscopy.


CONCLUSIONS
Correct localization of colorectal neoplasm or polypectomy site is mandatory before laparoscopic colorectal surgery. Virtual colonoscopy is a safe, minimally invasive three-dimensional imaging method and may be an alternative localization technique.
Baca
Bilgi
B
Department of Surgery, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey. bilgibaca@hotmail.com
Selçuk
Doğan
D
Kilic
Ilknur Erenler
IE
Erdamar
Sibel
S
Salihoğlu
Ziya
Z
Hamzaoğlu
Ismail
I
Karahasanoğlu
Tayfun
T
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D023881:Colonography, Computed Tomographic; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*