Laparoscopy Use in Cancer Staging, Colorectal Surgery and its Benefits

 

Introduction

Laparoscopy a conventional term for all video endoscopic abdominal surgical approach is important for the latest thing in supposed insignificantly obtrusive medical procedure. Laparoscopy or laparoscopy introduces into the world during the 1940s gynecological surgery; laparoscopy was then for symptomatic purposes as it were. It is since this date and particularly from the center of the seventies, that laparoscopy has created in gynecology to become restorative.

Use of Simulations is significant choice with Lap Trainer Box.

In instinctive and abdominal related a medical procedure; it was from the mid-1980s that this approach flourished to reach out to other surgical aptitudes. The sign of laparoscopy in our nations hampers by the hardships of obtaining the hardware, of preparing clinical and paramedical staff in its utilization and support. The act of laparoscopy started in 2004 with the response of cholecystectomy surgery.

Colorectal Surgery Interventions

Colorectal surgery represented 2.46% of interventions. Colorectal laparoscopy has experienced a resurgence of interest in recent years; the main factor influencing the results is the experience of the surgeon but especially the lack of materials necessary for colorectal dissection including haemostatic forceps. In a randomized study, the results were similar in the two procedures (laparoscopy and laparotomy) concerning morbidity, mortality and the quality of oncological excision. In our case, colorectal laparoscopy began in 2006 as part of an exchange. Appendectomy performs in few of the patients. Currently, laparoscopic surgery has become the reference technique in the management of acute appendicitis.

It allows a complete exploration, making it possible to rectify the initial diagnosis by the discovery of another pathology and /or a healthy appendix, especially in young women. In 1999, it reports that it was possible to perform laparoscopic appendectomy safely in day hospitalization, reporting a discharge rate of 75%. Recently in 2014, a prospective study conducted at St Antoine Hospital defined the necessary predictive criteria for the possibility of outpatient management of acute non- surgical appendicitis Complicated.

Laparoscopy Use in Cancer Staging

In cancer staging, most authors do not consider laparoscopy as an alternative to imaging, in this series laparoscopy (coelio staging) made it possible to avoid unnecessary laparotomy in patients with advanced cancer and in poor general condition).

The patients were cared for under general anesthesia with intubation and curarization, this is the method of choice in all the series. This curarization is essential to maintain a good CO2 pressure for pneumoperitoneum. The common in patients were ASA class I. This result is superior to those of other series which report 73.2% and 68.4% of ASA class I patients. This difference explains by the fact that their work essentially bases on laparoscopy. Emergency, unlike this series where the majority of patients schedules for scheduled surgery and therefore have received good preparation for prior.

Results of Diagnose in Laparoscopies

Among the gallbladder pathologies, there were more symptomatic gallstones than acute cholecystitis. These results are comparable to those of certain publications. The inflammatory state of the gallbladder links to a delay in consultations or a delay in diagnosis. The consequence of these delays in management is the complication of the clinical picture. It is essential to diagnose these cases of local inflammation in order to avoid unnecessary laparoscopies or conversion. The value of initial medical treatment with antibiotics demonstrates in the literature to cool the inflammatory picture.

The risk of operating on these patients in a state of local inflammation exposes them to wounds of the main bile duct and/or vascular. Conversion to conventional surgery is low in this series. The most important cause of conversion is the inflammatory state of the gallbladder and its pedicle. It ranges from 0 to 6.9% in the literature and varies according to indications. In France, the conversion rate out of 4624 patients was 6.9%, in the USA it was 4.6% out of 1771 patients. In the African series, this rate varies from 7.5% to 19%.

Benefits

Average Operating Time in Cholecystectomies

The average operating time is one hour with extremes ranging from 50 to 180 minutes, finds an average operating time of 60 minutes with extremes ranging from 30 to 90 minutes. This finds an average duration of 60.6 minutes with extremes ranging from 30 to 170 minutes. This time varies from 41 to 78 minutes in the recent literature on cholecystectomies. The time influences by the experience of the surgeon, the local intra-abdominal condition and the quality of the equipment.

In this series, 2.90% (n=13) of the total number developed a postoperative complication. This result is comparable to those of other series, which report a rate of 3.2%. Postoperative biliary leaks are observed in 6 cases of recorded complications. The causes of the bile leaks are in 4 cases due to the wounds of the main bile duct observed during the operation and in 2 cases they are due to the clamping of the bile duct which was taken for the cystic duct. As has been shown, biliary wounds occur most often with local inflammation. It recommends converting and or postponing cholecystectomy after medical treatment adequate.

Average Duration of Hospitalization

The average duration of hospitalization was 2.5 days with extremes ranging from 2 to 10 days. These results are similar to those of other publications where an average length of hospital stays of 2.6 days reports. In the literature, it varies from 0 to 3 days. In this series, the majority of patients left with a favorable outcome. 3 cases (0.65%) of death had been recorded, including 1 case for hemodynamic instability, 1 case for acute cholangitis and 1 case for post-transfusion hemolysis in sickle cell disease. In Western series, mortality varies between 0.2% and 0.05%. In the literature, mortality oscillates between 0 and 2%.

Conclusion

Laparoscopic surgery currently represents considerable progress in the surgical treatment of good number of conditions in digestive surgery. It little practiced in our surgical activities and its indications are restricted to a group of pathology due to the lack of certain materials. The indication mainly concerns cholelithiasis. It is essential to extend our indications in laparoscopic surgery to other pathologies. For this, much effort remains to makes in the establishment of infrastructure, the supply of materials and the training of nursing staff.

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