Definition colorectal disease.
The rapid acceptance and development of laparoscopic surgery, in many abdominal conditions, including urgent, is encouraging the spread of other diseases settled on the colon. Now accepted the surgery of the colon, in both benign and malignant processes.
Like any new technique must preserve the basic principles in relation to the results of traditional surgery. Also in this disease, patients require fewer doses in postoperative analgesia for less pain, earlier ambulation with a consequent decrease in respiratory complications and deep vein thrombosis, early onset of intestinal peristalsis, early oral intake and shortening of stay hospital.
Intra-operative complications, should be similar to those of conventional surgery, and most often appear during the learning curve for non-surgical experience.
The less aggressive surgical laparoscopy, allows faster incorporation of the patient to normal activity. Moreover, consideration of economic criteria, but expensive for this new technique, are alleviated by considering the average total laparoscopic procedure are lower than when conventional surgery is performed.
Laparoscopic procedures for colon inflammatory diseases and malignancies (cancers), represents a challenge for the surgeon, considering the difficulties of dissection and exposure of the operative field, but nevertheless has a clear advantage over the traditional way, that is the good vision magnifying images that captures the laparoscopic camera.
Laparoscopic surgery colorectal diseases.
Position of patient.
Patient supine, with legs spread legs and half bent over, the operating table in Trendelenburg 30-40 degrees and lateralized to the right, leaving the patient's left leg on a higher plane, thus achieving the displacement of small bowel top right, need for surgical manipulation in the left abdomen and pelvic bottom.
Location of the surgical team.
At the beginning of our experience, the surgeon and the first assistant with the camera are placed to the right of the patient and the second between the legs, the front laparoscopy tower and left the patient.
Currently we have varied the position and the two assistants are placed to the left against the surgeon. This positional change is determined by changes made to the position of entrance doors, in the course of time and experience.
Positioning of the trocars.
Umbilical door 10 mm, where we have made the pneumoperitoneum, through the Verres needle or open technique to Hansson, a second 12 mm trocar is implanted suprapubiano, these two doors are the surgeon's working channels, the two remaining trocars are placed in the left upper quadrant, the optics in the midclavicular line and the second more lateralized and lower level of the anterior axillary line, the last door is 12 mm and is used as a working channel of the assistant and ligation-section of the inferior mesenteric vessels with Endogia.
Laparoscopic surgical approach.
The technique of resection of left colon, is assisted by laparoscopy, the colon is mobilized with laparoscopic techniques, allowing the release of the left colic gutter parieto to the bottom pelvic ureter with identification of the same side, and vessel ligation inferior mesenteric.
The determination of the resection margins of the colon, is necessary in many cases the complete liberation of the splenic flexure.
The straight section at the sacral promontory with EndoGIA 30 or 60 releases the left colon to be removed by a mini suprapubic incision (about 12 mm trocar work). Resection of the part and the head positioning circular stapler is performed extracorporeal that laparoscopic becomes after the reintroduction of the same in the abdominal cavity and recovered the pneumoperitoneum.
The mini laparotomy, not closed, it is again inserted 12 mm trocar and approximating the edges of the wound with crab claws, the Laparoflator is capable of maintaining the pneumoperitoneum pressure, for fitting the anastomotic rectal circular stapler introduced by via transanal.
Laparoscopic localization of both dies, allowing the visualization and control of the output of the puncture of the lancet distal stump (punch) and its progression to the location of stem orange. The attachment of the lancet is important not to lose the abdominal cavity, after extraction with a endoloop.
Helping by pliers, attach the two parts of circular self-suture apparatus, and closed by turning on a routine basis, ensuring that no intervening tissue between them. Removed from the apparatus after opening and extraction rotation, checking the integrity of the impellers. Leak testing of the anastomosis, introducing air or methylene blue via transanal.
Placing a drainage tube in Douglas, exiting through a door, and closing of skin wounds, desufflation after the abdominal cavity.
Laparoscopic surgery postoperative.
As in all postoperative various laparoscopic techniques, also in colon surgery: They have less pain, recover peristalsis or as the first day of surgery and normalization of bowel function with bowel movement is usually between the third - The fourth day of the colon less trauma in laparoscopic surgery in relation to the conventional, is responsible for the prosperity of these patients postoperatively. Even the mini incision required for the extraction of the surgical specimen, does not reduce the benefits of laparoscopic surgery.