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KMID : 0978820090120010037
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2009 Volume.12 No. 1 p.37 ~ p.43
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Laparoscopic Colectomy: Technical Considerations
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Oh Yu-Gene
Choi Dae-Hwa
Cha Hee-Jung
Lim Young-Chul
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Abstract
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Purpose: Laparoscopic colectomy is technically demanding. Here we share of experience with laparoscopic procedures with focusing on (1) preoperative localization by a colonoscopic tattoo and (2) comparing the laparoscopic total mesorectal excision (lapaTME) with the conventional TME (openTME) according to microscopic examination.
Methods: We retrospectively collected 112 cases of laparoscopic colectomy that was performed for treating colorectal cancer during the past 6 years. Preoperative colonoscopic tattoo was done by using india ink. The tattoo cases were compared with the non-tattoo cases. Comparison between 13 cases of lapaTME and 15 cases of openTME was assessed by both gross and microscopic examination in the 28 cases for 9 months. The lapaTME and openTME were applied to mid-rectal cancer and mid & low rectal cancer, respectively.
Results: Tattoo was carried out for the Tis (100%), T1 (92%), T2 (72%), T3 (36%) cases. Of the significant cases, T3 lesion was not identified at laparoscopic colectomy. LapaTME grossly showed a greater incidence of defect than that of openTME, but there was no difference microscopically between lapaTME and openTME.
Conclusion: A tattoo was useful for early lesion and it should be considered for advanced lesion. LapaTME for mid-rectal cancer can be done without compromising the principles of TME.
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KEYWORD
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Laparoscopy, Colonoscopic tattoo, Total mesorectal excision
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