Laparoscopic Management of Colorectal Cancer

Abstract

Laparoscopy has improved the surgical treatment of various diseases due to its limited surgical trauma and has developed as an interesting therapeutic alternative for open colorectal surgery. The applicability of laparoscopy to colorectal diseases continues to expand. Generally laparoscopic management of colorectal diseases has a lot of advantages including decreased postoperative pain, early discharge from the hospital, less duration of postoperative ileus, less postoperative adhesions, less morbidity, less wound infection, less intraoperative blood loss, and improved cosmesis. Significant improvement of pulmonary function and the faster postoperative recovery of pulmonary complications compared with conventional surgery consider one of the important advantages. Longer operating time, Conversion rates and economic cost are considered the only disadvantages of laparoscopic management of colorectal diseases, but conversion rates vary widely between studies depending on patient selection, and which phase of the learning curve. There are relative contraindication of laparoscopic colorectal surgery such as old age, morbid obesity, previous abdominal surgery, site of the tumor and T4 colorectal cancer. Diffuse fecal peritonitis secondary to colonic perforation is absolute contraindication of laparoscopic colorectal surgery. There are well-documented complications (vascular Injuries, bowel and organ Injuries, anastomotic leak, thrombo-embolic complications and Port Site herniation or Recurrence). These are for the most part avoidable with good techniquean. In laparoscopic management of colorectal diseases, it is important to standardize the preoperative and the postoperative care plans, so that optimal results can be obtained. Also appropriate patient choice and differences in surgical techniques or surgeon’s skills may account for the great variability in outcome. In rectal cancer, technical hurdle as well as doubt on oncological clearance had once limited sphincter preservation to carcinomas located at the recto sigmoid junction or in the upper rectum. Progress in technology and skills, however, has finally led to the controversial extension of minimally invasive tech-niques to distal rectal cancer with sphincter preservation. The majority of the comparative studies found similar local recurrence rates for laparoscopic and open rectal cancer excision. The long procedure time of certain laparoscopic rectal cancer operations is of interest. Currently, it remains unclear as to how laparoscopic approach affects genitourinary function after rectal cancer excision. This is not only because of the limited yet conflicting data, but also because different criteria and methods of measurement were employed in different reports. Hand-Assisted Laparoscopic surgery has afforded significant benefits over conventional open surgery and thus has been incorporated into the surgeons' armamentarium. Hand-assisted laparoscopic surgery (HALS) has acquired a role in the evolution of laparoscopy. The limitations of laparoscopic surgery such as loss of direct tactile sensation, diminished depth perception, and retrieval of organs are compensated by the insertion of a hand into the laparoscopic field. HALS has a lot of advantages including allowing for tactile sensation working space, specimen retrieval and anastomosis may be performed through hand port site, rapid control of bleeding by direct pressure, improved depth perception and shortened learning curve, avoidance of conversion to open approach and Reduced operative time. On other hand HALS has disadvantages such as hand encroaches upon intra-abdominal, may reduce benefit of laparoscopic procedure secondary to larger hand port, large incision at risk for incisional hernia, Device-dependent air leak, ergonomically unfavorable, leading to shoulder and forearm fatigue and strain and increase cost. Single incision laparoscopic surgery is safe, effective, and beneficial for the treatment of both benign and malignant diseases. The advantages of the minimally invasive approach are likely related to the significant reduction of surgical trauma compared with standard open procedures. Researches in minimal invasive surgery and the technological improvements in instruments, has marked the rebirth of the single-incision approach. Several reports demonstrated that reducing the number and size of the laparoscopic trocars has an effect on the surgical outcome in terms of postoperative pain and cosmetic results. Robotic colectomy can play an important role in complex procedures such as dissection of lymph nodes around major vessels, owing to its stable camera platform and articulated instruments that eliminate tremor. Lymphadenectomy during laparoscopic colon resection is still a technically demanding procedure. One potential benefit of robotic colectomy is the ability to perform intracorporeal anastomosis. Intracorporeal anastomosis entails several advantages, such as less mobilization of the colon, reducing complications related to the exteriorization of the bowel mesentery and a smaller abdominal incision for specimen extraction. The current robotic operative system has the advantages over laparoscopic TME, stable vision, 3-dimensional view, The magnified vision, superior dexterity, multi articulated instruments facilitate sharp dissection and autonomic nerve identification in the narrow pelvic space and pelvic floor and precision of the movements of the robotic arms. Therefore, robotic platforms are particularly suited for operations that require a relatively small anatomical field in which great precision is essential, such as cardiac surgery, urogynecologic surgery, and rectal surgery