[Robotic surgical system combined with colonoscopy for colon tumor resection and D1 lymph node dissection].
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目的： 探讨机器人手术系统联合结肠镜治疗结肠镜下难以切除的良性肿瘤及早癌的可行性。 方法： 采用描述性病例研究方法。患者为男性68岁，1年前曾行腹腔镜下直肠癌根治术，术后病理为pT3N1a。因结肠镜检查提示距肛门40 cm处可见宽基底结节样隆起、大小1.8 cm×1.8 cm，呈浸润样生长，黏膜表面粗糙，黏膜下注射甘油果糖后病变抬举不良，考虑为结肠镜下难以切除性病变，癌变不能除外，病理示管状腺瘤，局灶高级别上皮内瘤变。于2022年4月11日采用外科手术治疗。首先，采用结肠镜定位结肠肿瘤并以纳米碳标记，在机器人下行肿瘤区域肠壁裸化及第一站淋巴结清扫（D1）；然后，在机器人手术系统监视下，利用结肠镜自结肠腔内全层切除肿瘤；最后，采用机器人手术系统修复肠壁缺损。 结果： 患者术后6 h饮水，12 h下床活动，24 h内排气并流质饮食，5 d后顺利出院。 结论： 机器人与结肠镜优势互补，进行结肠肿瘤切除安全可行，微创效果明显。.Keywords:
Colon resection
Aim: to evaluate the early results of endoscopic submucosal tunnel dissection (ESTD for large benign colon neo-plasms. Patients and methods: a prospective non-randomized comparative study included 100 patients with large benignepithelial colon neoplasms (more than 3 cm in diameter). The main group included 50 patients who underwentendoscopic submucosal tunnel dissection. The control group included 50 patients who underwent traditional endo-scopic submucosal dissection (ESD). Results: Four (4 %) patients (1 in the main and 3 in the control group) were excluded from the study due to theconversion of endoscopic procedure. The incidence en bloc removal of neoplasms and the negative resection margins were significantly higher in the main group than in the control one — 98 % and 87.2 % (p = 0.04) and 89.8 % and 70.2 %, respectively (p = 0.01). Conclusion: ESTD for large benign epithelial colon neoplasms shows better radicalness in comparison with endo-scopic submucosal dissection.
Endoscopic submucosal dissection
Colon resection
Endoscopic mucosal resection
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INTRODUCTION: Colonic lesions referred for endoscopic mucosal resection (EMR) may not be amenable to conventional snare resection due to previous manipulation or submucosal invasion or because of flat lesions unable to be snared. In 2018, we initially described Dissection-enabled Scaffold Assisted Resection (DeSCAR)—a combination of circumferential endoscopic submucosal dissection (ESD) with EMR—to be safe for the endoscopic resection for removal of non-lifting or residual colonic lesions with suspected submucosal involvement or fibrosis. We describe our expanded experience and follow up of patients undergoing DeSCAR and assess the efficacy, safety, and feasibility of DeSCAR for endoscopic resection of non-lifting or residual colonic lesions. METHODS: Lesions referred for EMR were retrospectively reviewed. Our initial cohort of 29 patients from 2015-2017 combined with 28 additional patients from 2018-2019 were identified where the DeSCAR technique was performed for colonic lesions with incomplete lifting and/or snaring. Cases were reviewed for location, prior manipulation, rates of successful hybrid resection, adverse events, and endoscopic follow up to assess for residual lesions. RESULTS: 57 lesions underwent DeSCAR for non-lifting or residual colonic lesions. Patients were 51% female and 49% male with an average age 69 (SD +/- 9.6 yrs). Lesions were located in the cecum (n = 16), right colon (n = 22), transverse colon (n = 5), left colon (n = 7), rectum (n = 4), or in other locations defined by distance from the anus (n = 4). Average lesion size was 27.7 mm (SD +/- 16.6 mm). Previous manipulation occurred in 54 of 57 cases (68% biopsy, 47% resection attempt, 18% intralesional tattoo). The technical success rate for resection of non-lifting lesions was 100%. There were two delayed bleeding episodes (one required endoscopic intervention) and one small perforation (managed by successful endoscopic hemoclip closure at the time of perforation). No other adverse events were observed. Endoscopic follow up was available in 27 patients (47%) with no residual adenoma noted in 25 patients (93% of those with surveillance). CONCLUSION: Our expanded experience with DeSCAR continues to demonstrate a high safety, feasibility, and effectiveness profile for the endoscopic management of non-lifting or residual colonic lesions, providing en-bloc resection of tissue for histologic review. Further studies are needed to demonstrate long-term eradication and direct comparison with other currently available endoscopic techniques.
Endoscopic mucosal resection
Endoscopic submucosal dissection
Transverse colon
Cecum
Anus
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A comparative analysis of the performance of 51 operations for resection of various parts of the colon, among which were 24 operations conducted by laparoscopy, was undertaken. Certain advantages of laparoscopic resection of the colon, as well as the possibility of lymph dissection, which meets the principles of oncological surgery, were revealed.
Colon resection
Colorectal Surgery
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Colonoscopy is an effective method for discovery of adenomas and for colon cancer screening and prevention. Studies evaluating back-to-back colonoscopies have estimated significant miss rates but are limited by the lack of a definitive gold standard. Our study evaluated the sensitivity of colonoscopy compared with examination of surgically resected colon as a gold standard.This was a retrospective analysis of patients who had a portion of colon surgically removed and had lower endoscopy within 5 months. The focus of the review was not for the particular lesion for which the surgery was indicated but, rather, for the synchronous lesions in the portions of bowel that were removed. Sensitivity was determined by counting the number of lesions detected at colonoscopy compared with those found in the surgically resected segment.A total of 73 synchronous lesions were present in the resected segments of 156 patients. Colonoscopy detected 56 of 73 the lesions (sensitivity 76.7%: 95% CI = 67-86). Of the 17 missed lesions, 14 of 17 (82%, 95% CI = 64-100) were < 1-cm polyps. Endoscopy overlooked one 1-cm adenoma in the ascending colon. Two cancers were missed, both in the same patient in whom endoscopy detected a sigmoid cancer but missed synchronous lesions in the cecal and ascending colon.Colonoscopy is an effective method of finding cancers and polyps, but it is associated with significant miss rates for polyps <1 cm. The entire bowel should be carefully evaluated to exclude synchronous tumors in patients with known colorectal cancer. Further improvement of colonoscopic techniques and technologies is warranted.
Proximal colon
Distal colon
Colon resection
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With increase in the incidence of right colon cancer, the proportion of laparoscopic right colon resection is increasing. Though the advantage of laparoscopy in minimal invasiveness has been widely accepted, its procedure still possesses certain difficulty. In this article, we shared the experience of laparoscopic right colectomy, including entering the correct Toldt's place, management of ileocolic and middle colic vessels and the problems of D3 lymph node dissection. Basic surgical techniques and several difficulties are discussed here, which may be helpful for beginners.
Colon resection
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Objective To investigate the left hand control technology in complete mesocolic excision( CME) in patients with right colon cancer. Methods Seventy patients with right colon cancer were divided into study group and control group( 35 cases each),in which,the full right colon mesentery resection and left hand control technology was used in the study group,and conventional surgical methods in the control group. Surgical results and prognosis were compared. Results Operative time,blood loss,postoperative exhaust defecation time,postoperative complications,length of hospital stay had no significant difference between two groups,but there was significant difference between the two groups in the number of lymph node dissection. In study group,the mean number of lymph node dissection was significantly higher than the control. Follow- up in study group found that 3 cases had recurrence( 8. 82%) and 1 patient died( 2. 94%),but in control group,we found 9 cases of recurrence( 27. 3%) and 6 cases( 18. 18%) died. Recurrence and mortality in study group was significantly lower than the control group. Conclusion The left hand control technique in CME can significantly improve overall survival rate in patients with right colon cancer compared with conventional surgical procedures.
Colon resection
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Objective Randomized comparative study of laparoscopic radical resection of right colon D3 effect of laparotomy lymph node dissection during the same period. Methods Through the investigation of the recent 2 years(June 2011 to June 2013)in 37 cases of laparoscopic radical resection of right colon and laparotomy in 31 cases over the same period,duration of operation,the number of lymph node dissection and postoperative complications,hospital stays and other indicators for comparative analysis study. Results Preoperative information are not significantly different in two groups;group laparoscopic surgery takes longer than laparotomy group,shorten hospital stay than the laparotomy group, the incidence of postoperative complications was not statistically significant,the number of laparoscopic lymphadenectomy group increased significantly compared with the open group(P 0. 05). Conclusion In the laparoscopic group significantly reduced patient length of stay at the same time,radical lymph node dissection of right colon D3 also highlights certain advantages.
Lymphadenectomy
Colon resection
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Diverticulitis
Limiting
Colon resection
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Laparoscopic-assisted colectomy for colon cancer has been tried in these 5-6 years in Western countries. In Japan, this procedure has been used since about three years ago. In this country, the indication for laparoscopic-assisted colectomy has been either colonic adenomas or carcinomas in early stage which are not suitable for colonoscopic removal. The application of this procedure to more advanced carcinomas with invasion in the muscularis propria or invasion penetrating the muscularis propria is controversial. This is because of the technical difficulties involved in the lymph node dissection which is usual procedure for these invasive carcinomas in the usual laparotomy operation. We have carried out laparoscopic-assisted colectomy and lymph node dissection for colorectal carcinomas with invasion in the submucosa or deeper. In this study, we present the technical aspect of lymph node dissection in the laparoscopic procedure, and discuss the indication and technical problems in this procedure.
Submucosa
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