Laparoscopic colorectal resection was first performed in 1991.([FOOTNOTE=Fowler DL, White A. Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc. 1991 Sep;1(3):183-8.],[ANCHOR=],[LINK=]),([FOOTNOTE=Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991 Sept;1: 144–150.],[ANCHOR=],[LINK=]) Initially, when used for removal of tumors in patients with colorectal cancer there was concern over the high incidence of port-site metastases. This has now largely been negated due to improved technique isolation of diseased tissue prior to extraction and rates of port site metastases with laparoscopic colectomy are now similar to rates of metastases around the edge of the wound site reported with open colectomy.([FOOTNOTE=Lacy AM, Delgado S, García-Valdecasas JC, et al. Port site metastases and recurrence after laparoscopic colectomy. A randomized trial. Surg Endosc. 1998 Aug;12(8):1039-42.],[ANCHOR=],[LINK=]),([FOOTNOTE=Bărbulescu M, Alecu L, Boeţi P, Popescu I. Port-site metastasis after laparoscopic surgery for colorectal cancer--still a real concern? Case report and review of the literature. Chirurgia (Bucur). 2012 Jan-Feb;107(1):103-7.],[ANCHOR=],[LINK=]),([FOOTNOTE=Martel G, Crawford A, Barkun JS, et al. Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials. PLoS One. 2012;7(4):e35292.],[ANCHOR=],[LINK=]) Laparoscopic colectomy has several benefits compared with open colectomy and is becoming increasingly widely used across both developed and emerging markets. However, as operating time is typically longer with laparoscopic colectomy versus open there is demand in some settings to demonstrate tangible clinical benefit and cost-effectiveness of the use of laparoscopic techniques.
US data show that 37% of laparoscopic colectomies are performed in patients with primary malignant neoplasm, 29% for diverticular disease and 19% for benign neoplasms([FOOTNOTE=Wilson MZ, Hollenbeak CS, Stewart DB. Laparoscopic colectomy is associated with a lower incidence of postoperative complications than open colectomy: a propensity score-matched cohort analysis. Colorectal Dis. 2014 May;16(5):382-9.],[ANCHOR=],[LINK=]) and in 2015 there will be an estimated 132,700 cases of colorectal cancer in the United States, which represents 8% of total cancer cases in the US making it the fourth most common cancer.([FOOTNOTE=SEER Stat Fact Sheets. Colon and Rectum Cancer. National Cancer Institute (United States) Website. Accessed July 27, 2015.],[ANCHOR=View Stat Facts],[LINK=http://seer.cancer.gov/statfacts/html/colorect.html ]) Surgery (laparoscopic or open) is the only curative treatment for colorectal cancer and encompasses complete resection of the primary tumor with negative margins in addition to a complete oncologic lymphadenectomy.
The removal of the cecum, ascending colon, hepatic flexure, initial third of the transverse colon and part of the terminal ileum (in addition to removal of fat and lymph nodes). Laparoscopic right colectomy involves a total of four surgical incisions and insufflation of the abdomen with carbon dioxide. Prior to any mobilization the surrounded area is examined for the presence of metastases, after which the colon is divided from its posterior and lateral attachments and ileocolic vessels ligated. The ascending colon is then transected from the ileum and transverse colon and removed after deflating the abdomen. Finally, an anastomosis is created between the ileum and transverse colon.
The removal of the left (descending) colon. The laparoscopic procedure requires approximately five small incisions. The renocolic, splenocolic and pancreatic colic ligaments are first cut to remove the descending colon from its attachments. The mesentery and the major vessels it contains must be ligated and divided. The omentum is divided from the transverse colon, splenic flexure mobilized and the necessary length of diseased bowel removed. An anastomosis is then created between the transverse and sigmoid colon.
The removal of the rectum and sigmoid colon, removal of the sigmoid colon (from the splenic fixture to the rectosigmoid junction) and removal of the rectum, respectively. The laparoscopic procedure involves three to five incisions and the colon transected 5–10 cm on either side of the tumor (or at the rectosigmoid junction); in proctosigmoidectomy the upper section of the rectum is also removed. After which, in cases of colorectal carcinoma, the excised tissue can be placed in a specimen bag and removed through the excisions or removed through a wound protector at the wound site to prevent contact of malignant cells with healthy tissue. An anastomosis is then created.
The removal of a segment of the rectum (subtype of proctectomy), as well as associated lymph nodes in the case of surgery for colorectal cancer. The procedure is less extensive than abdominal perineal resection and a colostomy is not required; an anastomosis is created between the remaining part of the colon and rectum.
Also known as the Miles operation, the removal of the anus, rectum and part of the sigmoid colon (in addition to lymph nodes), used in cases of rectal carcinoma in the distal third of the rectum). A colostomy is created by pulling the end of the sigmoid colon through the abdominal wall. The creation of a colostomy involves creating an opening (stoma) for the large intestine in the abdomen wall through which stool can exit into an external bag (colostomy bag). Colostomies are associated with impairment in some aspects of HRQoL; in a study of Japanese patients with colostomies >7 years post-surgery, significantly lower scores relative to the general population were reported in physical and social functioning domains but there was no significant impairment in any other domain.