Totally Laparoscopic Right Colectomy: Theoretical and Practical Advantages over the Laparo-assisted Approach
Totally Laparoscopic Right Colectomy: Theoretical and Practical Advantages over the Laparo-assisted Approach
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DOI：
10.1089/lap.2012.0420
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发表时间：
2013-05-01
影响因子：
1.3
通讯作者：
Roncoroni, Luigi
中科院分区：
文献类型：
--
作者：
Marchesi, Federico;Pinna, Ferdinando;Roncoroni, Luigi
背景：体内吻合技术的改进以及随后从腹腔辅助（LA）到完全腹腔镜（TL）右结肠切除术的转变似乎已经克服了最初的担忧，从而引起了这种手术的广泛使用。通过比较 LA 和 TL 方法，我们的研究旨在验证最新技术的可能优势，同时也关注对外科医生的一些技术影响。 对象和方法：我们前瞻性地收集并匹配了 27 例连续 LA 右侧结肠切除术和 28 例连续 TL 右侧结肠切除术 (TLRC) 的数据。检查临床、生化、病理和美容参数。记录和分析手术时间，以评估手术不同阶段的学习曲线。结果：LA 和 TL 组的人口统计学和病理特征是同质的。我们没有死亡，手术并发症发生率相似（3.6% 与 3.7%）。 TLRC 组的剖腹手术时间显着缩短（4.8 厘米与 7.2 厘米，P = .002），而结果参数没有记录到显着差异。 TL 组进行吻合的手术时间明显更长（55.6 分钟 vs 20.6 分钟，P < .0001）。整个系列中吻合时间的快速减少证明了体内回肠横行吻合术的学习曲线较短。结论：需要进一步的研究来证明 TLRC 相对于 LA 方法可能的临床优势。对患者的美容益处以及对外科医生的安全性和预期有用性（体内缝合技术的实践）似乎证明了这种技术发展的倾向。
Background: The improvement in intracorporeal anastomotic techniques and the consequent switch from a laparo-assisted (LA) to a totally laparoscopic (TL) right colectomy seem to have overcome the initial concerns, giving rise to the widespread use of such a procedure. By comparing the LA and TL approaches, our study was aimed at verifying the possible advantages of the more recent technique, while also focusing on some technical implications for the surgeon.Subjects and Methods: We prospectively collected and matched data from 27 consecutive LA right colectomies and 28 consecutive TL right colectomies (TLRCs). Clinical, biochemical, pathological, and cosmetic parameters were examined. Operating times were recorded and analyzed, in order to evaluate the learning curve for the different phases of the procedure.Results: The LA and TL groups were homogeneous for demographic and pathological features. We had no mortality, and surgical complication rates were similar (3.6% versus 3.7%). The TLRC group presented a significantly shorter laparotomy (4.8 cm versus 7.2 cm, P = .002), whereas no significant difference was recorded for outcome parameters. Operating time for carrying out anastomosis was significantly longer for the TL group (55.6 minutes versus 20.6 minutes, P < .0001). A rapid decrease in anastomosis time throughout the series attests to a short learning curve for intracorporeal ileotransverse anastomosis.Conclusions: Further studies are needed to demonstrate possible clinical advantages of TLRC over the LA approach. The cosmetic benefit for patients along with safety and the prospective usefulness for surgeons (practice in intracorporeal suturing techniques) would seem to justify an inclination toward this technical development.