The methodology to stylize the laparoscopic surgery for colon cancer for education and tradition

Hidekazu Takahashi, MD, Ichiro Takemasa, MD, Naotsugu Haraguchi, MD, Junichi Nishimura, MD, Yasushi Hata, MD, Hirofumi Yamamoto, MD, Tsunekazu Mizushima, MD, Yuichiro Doki, MD, Masaki Mori, MD. Osaka University Graduate School of Medicine, Gastroenterological Surgery

Recent laparoscopic surgery benefit surgeons due to the microscopic effect of the targets and knowledge of micro-anatomy obtained through high quality visualizations under HD image. Thus, by performing laparoscopic surgery with fine and accurate manipulation, surgeons could pursuit high quality and convincing procedures yield to the procedures conducted by conventional operation through major laparotomy. However, acquisition of appropriate technique for laparoscopic surgery is challenging and surgeons should at least aware of laparoscopic-surgery specific weak point such as difficulty of acquisition of wide and bird visualizations to accomplish safe and adequate procedure. In this line, for education and tradition of laparoscopic surgery, adequate training and standardized technique thought to be critical.

Here, we present our original efforts to overcome these difficulties in laparoscopic surgery for colon caner. First, 3-dimentional (3D)-triple fusion virtual images, which were constructed from multi-directional computed tomography (MDCT)/positron emission tomography (PET) and air-colonography, were routinely obtained for decision of operative strategy; e. g., dimension of lymph node dissection and location of ligation of the vessels, shared by all operative team members preoperatively. Second, perioperatively, surgeons refer obtained 3D-triple fusion virtual images for the navigation surgery on demand. By doing these, surgeons could perform dissection by carefully tracing the “embryologic tissue plane” to accomplish complete mesocolic excision (CME) and central vascular ligation (CVL) which thought to be indispensable for curative resection for colon cancer.

From 2004 to 2011, 511 laparoscopic surgery for advanced colon cancer were performed in line with our original efforts described above. The mean operative time was 175mins and the mean blood loss was 30g. Five-year disease free survival rate was 86.7% at stageII and 76.1% at stageIII, respectively. Since 2009, we have been applied our method for single incision laparoscopic surgery and performed 350 cases. In the presentation, we also show representative movie of the case of single incision laparoscopic hemi-right colectomy. 

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