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The optimal approach to port-site placement in laparoscopic colorectal surgery

The optimal approach to port-site placement in laparoscopic colorectal surgery. Sandeep Patel SpR General Surgery North Middlesex Hospital. Laparoscopic Colorectal Surgery. No difference in oncological outcome No difference in complications (Cochrance Review 2012)

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The optimal approach to port-site placement in laparoscopic colorectal surgery

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  1. The optimal approach to port-site placement in laparoscopic colorectal surgery Sandeep Patel SpR General Surgery North Middlesex Hospital

  2. Laparoscopic Colorectal Surgery No difference in oncological outcome No difference in complications (Cochrance Review 2012) Shorter hospital Stay and improved patient experiences Laparoscopic Colorectal Surgey should be offered both options are feasible and surgeons are adequately trained

  3. How do we reach a standard? Training Preceptorship/Fellowship/Clinical Attachment/Pioneer Standardised steps in performing laparoscopic colorectal surgery

  4. Aims and Methods • To assess port-site placement (amongst other variables in common procedures • Survey Questionnaire • 115 Practicing Laparoscopic Colorectal Surgery • 55% > 50 resections Trainer group • 24% < 50 resections Training group

  5. RH Learners and Experienced

  6. AR Learners and Experienced

  7. Specimen delivery

  8. Conclusions • Low response rate – 28% • Formal training – 84% (16% self learners) • Number needed? • Tekkis et al. 55 RH and 62 AR • RH variation vs AR conformity • Specimen site – ERP • No NICE guidance • Other factors – pathology/BMI

  9. References • 1. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350(20): 2050-2059. • 2. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005;365(9472): 1718-1726. • 3. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2008(2): CD003432. • 4. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 2006;93(8): 921-928. • 5. Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA. Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc 2009;23(7): 1660-1666. • 6. NICE. Guidance on the use of laparoscopic surgery for colorectal surgery. Technology appraisal TA17. 2000. • 7. NICE. NICE implementation uptake report: Laparoscopic surgery for the treatment of colon cancer. Technology appraisal TA105. 2006. • 8. Harinath G, Shah PR, Haray PN, Foster ME. Laparoscopic colorectal surgery in Great Britain and Ireland--where are we now? Colorectal Dis 2005;7(1): 86-89. • 9. Schwab KE, Dowson HM, Van Dellen J, Marks CG, Rockall TA. The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI. Colorectal Dis 2009;11(3): 318-322. • 10. Pigazzi A, Anderson C, Mojica-Manosa P, Smith D, Hernandez K, Paz IB, Ellenhorn JD. Impact of a full-time preceptor on the institutional outcome of laparoscopic colectomy. Surg Endosc 2008;22(3): 635-639. • 11. Williams GL, Sagar PM, McAllister I, Gonsalves S. The laparoscopic colorectal fellowships are popular, educational and produce competent laparoscopic surgeons. Colorectal Dis 2009;11(5): 519-521. • 12. Poulin EC, Gagne JP, Boushey RP. Advanced laparoscopic skills acquisition: the case of laparoscopic colorectal surgery. Surg Clin North Am 2006;86(4): 987-1004. • 13. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL. Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 2004;18(8): 1163-1185. • 14. Neudecker J, Bergholz R, Junghans T, Mall J, Schwenk W. Laparoscopic sigmoidectomy in Germany--a standardised procedure? Langenbecks Arch Surg 2007;392(5): 573-579. • 15. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 2005;242(1): 83-91. • 16. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 2001;44(2): 217-222. • 17. Shah PR, Joseph A, Haray PN. Laparoscopic colorectal surgery: learning curve and training implications. Postgrad Med J 2005;81(958): 537-540

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