Laparoscopic Colon Surgery Dr. Shahram Nazari, MD SAGES,ELSA Consultant & Lecturer in Surgery, Department of General and Laparoscopic Surgery, Milad Hospital, Tehran, Iran dsnazari@yahoo.com www.dr-nazari.com

In 1902 Kelling reported the first successful endoscopic examination of the abdominal cavity. A few years later Jacobeus advocated the use of this procedure in patients with ascites and for the early diagnosis of malignant lesions.

Introduction1 Laparoscopy was initially limited to easy procedures such as cholecystectomy or appendectomy. Minimally invasive operations were aggressively developed in the 1990s. Advanced laparoscopic techniques such as antireflux surgery,Heller`s cardio myotomy, CBD explorations. Laparoscopy was proposed for colorectal surgery as early as 1991. The widespread use of laparoscopy for the diagnosis and surgical treatment of diseases of the abdomen and pelvis is continuously expanding the scope of laparoscopic procedures.

Introduction2 The potential roles for laparoscopy in the treatment of colonic diseases include diagnosis, drainage, diversion, removal of the affected segment, and reconstruction of Hartmann’s procedure, and anastomosis. However, laparoscopic colorectal surgery remains a challenge because in this procedure the field of action is wider than in other advanced laparoscopic techniques. The place of laparoscopic-assisted colectomy for colorectal carcinoma is controversial.

Benign (non-cancerous) problems which may require surgery 1 Adenomatous Polyps Diverticular Disease

Benign (non-cancerous) problems which may require surgery 2 Familial or Hereditary Polyposis Inflammatory Bowel Disease Crohn's Colitis Ulcerative Colitis

Colon Cancer Colon Cancer

Specialized instruments used in laparoscopic surgery of the colon and rectum.

Advantages of Laparoscopic Colon Resection Reduced postoperative pain More rapid return of normal bowel function Faster return to solid food Shorter hospital stay Faster return to everyday activities Improved cosmetic results May result in reduced formation of scar tissue inside the abdomen

Aims of this study To evaluate the feasibility of laparoscopic colectomy. To evaluate the safety aspects of this approach.

Methods Between April 2005 and December 2006 10 consecutive patients underwent LCS in two non academic hospitals by the author. There were 8 females and 2 males with a mean age of 37.5 (range 22-67) years.

Indications for surgery Diverticulitis (1 patient) Adenocarcinoma (3 patients) Obstructing sigmoidocele with prolapse (1 case) without prolapse (2 cases) Dolichosigmoid (3 patients)

Results 1 8 females and 2 males Mean age of 37.5 (range 22-67) years Mean operation time was 200 Min (range, 160 - 290) No conversion No anastomosis leakage No post-operative death 2 port site hernia in one patient 3 port site infections in 3 patients

Results 2 Laparoscopic sigmoidectomy in 5 cases -with intracorporeal stapler with colorectal anastomosis in 4 cases -extracorporeal hand-sewn anastomosis in 1 case Laparoscopic assisted right hemicolectomy (with extracorporeal hand-sewn anastomosis in 1 case) Laparoscopic assisted left hemicolectomy (with extracorporeal hand-sewn anastomosis in one case) Rectopexy without sigmoid colon resection(3 cases)

Discussion Recent advances in minimal access surgery of the colon have made laparoscopic or assisted colorectal resection an attractive alternative to open surgery . Elective laparoscopic or assisted colectomy may be feasible and safe. In selective cases the complications are few.

Complications Specifically attributed to the nature of disease: Specifically attributed to the laparoscopic technique: Specifically attributed to the instruments: Specifically attributed to the Surgeon (Learning Curve)