الفهرس 
Anatomy of the colonOnly 14 pages are availabe for public view
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Abstract
Minimally invasive surgery has gained tremendous popularity
after the success of laparoscopic cholecystectomy. With the
promise of smaller incisions, less pain, and quicker recovery,
minimally invasive techniques have been applied to an
increasing variety of surgical procedures. Laparoscopic
appendectomy, splenectomy, and adrenalectomy have been
accomplished, and attempts at more complex procedures such
as colon and rectal resection have been explored.
Laparoscopic colorectal surgery is the most significant
technical development in colorectal surgery over the last
decade, and is likely to have a significant impact on the
training and delivery of colorectal surgery.
Laparoscopic colonic resection is a challenge. It requires
dissection in multiple parts of the abdomen, isolation and
ligation of major arteries and veins, division of colonic
attachments, identification
and preservation of critical retroperitoneal structures, intestinal
division, and reconstruction of bowel continuity. All of this is
done with loss of tactile sensation.
Major disadvantages of laparoscopic colectomy include
increased operative time; most studies report a 30 to 75 minute
increase in surgical time using the minimally invasive
approach, significant learning curve; 20-50 cases needed for
laparoscopic colectomy to achieve the learning curve.
Operative time decreases significantly as the number of
procedures performed by the operating surgeon increases.
Summary
197
Laparoscopic colorectal surgery is now being performed
routinely for benign processes such as inflammatory bowel
disease, rectal prolapse, benign polyps, and diverticular
disease.
Laparoscopic resection is not inferior to open resection of
colorectal cancer. This is likely due to technical principles that
are maintained during both open and laparoscopic operations,
including the ligation of the primary feeding vessel at its base,
minimal and atraumatic handling of the tumor and accrual of at
least 12 lymph nodes with adequate margins of 5cm proximal
and 5cm distal to the tumor. Cancer-related survival rates, and
rates of complications and mortality are the same whether the
operation is performed open or laparoscopically.
Now laparoscopic colectomy has become a standard procedure
for curable cancer colon and rectum provided that surgical
margins, number of lymph nodes and high vascular ligation to
preserve oncologic standard.
Laparoscopic colectomies are performed under general
anesthesia and involve using multiple ports placed through
small abdominal incisions usually 0.5-1cm long. Carbon
dioxide gas is then used to inflate the abdomen. A thin
laparoscope is placed through a port to see inside the abdomen.
Dissection is performed with specially constructed thin
instruments that are placed into the abdomen through ports.
A small incision, often less than one-third the length normally
required in open colectomy, is utilized to remove the specimen
at the end of the procedure.
Summary
198
There is considerable variability in laparoscopic techniques for
colon resection. Some surgeons perform only a portion of the
procedure laparoscopically, and then make an incision to
complete the resection (laparoscopic assisted colectomy).
Others perform the complete resection laparoscopically. Others
perform hand-assisted laparoscopic surgery.
Conversion from the laparoscopic to an open procedure is done
in cases of intra-operative complication such as bleeding; the
discovery of more advanced disease than anticipated; the
presence of adhesions or scar tissue from previous surgery; and
an inability to visualize key anatomic structures. If the decision
of conversion is done early, the operative time and the cost of
operation are not affected.
Laparoscopic colectomy is associated with earlier
postoperative recovery. Patients who undergo a laparoscopic
colectomy can resume an oral diet earlier than those
undergoing an open colectomy due to early return of normal
intestinal peristalsis. Patients are generally discharged from the
hospital after they can tolerate an oral diet and when their
postoperative discomfort can be controlled with oral pain
medication. Most studies have shown that patients who
undergo laparoscopic colectomy are discharged from the
hospital 1-3 days earlier than patients who undergo open
colectomy. Long-term convalescence also appears to be
quicker following laparoscopic surgery.
The most frequent postoperative surgical complications after
colorectal resections are surgical site infection, anastomotic
leakage, intra-abdominal abscess, and bleeding.
Summary
199
Laparoscopic colorectal surgery will continue to flourish in the
coming decades. This is reflected by the establishment of
various endo-laparoscopic operating suites, robotic surgery
centres, and training centres on laparoscopic surgery.