Minerva Surgery最新文献

Background: Routine splenic flexure mobilization (SFM) during left hemicolectomy and high anterior rectal resection guarantees a well perfused and tension-free anastomosis, respecting current oncological criteria. According to the recent literature, only 70% of laparoscopic colorectal surgeons considered routine SFM mandatory. Because of its difficulty, SFM increases morbidity including surrounding organs injuries. The goal of the study is to report our experience in avoiding routine SFM during colorectal resection compared to the current surgical state of art.

Methods: Data were collected retrospectively on elective left hemicolectomy without routine SFM performed in our unit between January 2015 to April 2020. Patients were recruited according to diagnosis, histopathology, operative time, ASA score, post-operative morbidity and mortality.

Results: Seventy-five oncological patients, underwent to surgery without SFM. The other 13 patients underwent to SFM due to technical issues. The mean operative time was 160.2±44.7 mins, significantly shorter than in patients whose SFM occurred (210.3 min). The morbidity rate was 1%, reintervention occurred in one patient. Eighteen-month median follow-up morbidity was 11% while mortality was 3%. Recurrence rate was of about 5%.

Conclusions: As results from study data analysis, left colectomy can be conducted safely in both laparoscopic and laparotomic approach without SFM in selected cases. As reported in a recent meta-analysis, benefits of avoiding SFM concern reduced operative time without compromising postoperative outcome and respecting oncological criteria, as emerged by our results. Colorectal resection without SFM when is feasible, improves surgical approach reducing technical difficulties and avoiding splenic injuries.

The paper entitled " Clinical study of correlation between TICL rotational stability and visual quality of operative eye " by Lanfang XUE et al, which was published online on June 5, 2024, has been withdrawn by the Publisher after the authors requested its withdrawal.

Background: Complete mesocolic excision (CME) has been introduced from open surgery, to compare right colon cancer surgery to total mesorectal excision for rectal cancer and it is currently being applied by robotic approach. CME concept is based on the complete removal of right mesocolon and the dissection deep at the level of the central feeding vessels. Aside the CME, intracorporeal anastomosis completes a total minimally invasive approach to the treatment of right colon cancer. This study retrospectively analyzed the feasibility and efficacy of robotic CME and intracorporeal anastomosis in a cohort of consecutive patients affected with right colon cancer.

Methods: The data of 110 patients undergone a robotic CME with IA anastomosis for right colon cancer from 2018 to 2023 were prospectively collected and retrospectively analyzed. Intraoperative, postoperative, and short-middle term outcomes were considered for analysis, as well as pathologic and oncologic outcomes. A time-to-event analysis was performed using the Kaplan-Meier method for OS and DFS.

Results: All patients underwent a robotic right colectomy. Median operative time was 184 min, blood loss was negligible, no intraoperative complications occurred. Three conversions (2.7%) were experienced due to bulky lymph nodes and severe local advanced tumor. Mean postoperative stay was 6 days. Six postoperative complications occurred, 4 postoperative ileus, 1 late dehiscence of the colonic stump and an iatrogenic colonic perforation. The latter needed reintervention.

Conclusions: Robotic CME with central vessels ligation seems feasible and safe, with acceptable morbidity and adequate short-middle term outcomes.