Surgical Technology International
37th Edition
Contains 62 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
432 pages
Nov 2020 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Right Colon Resection: Evolution and Surgical Technique
Mahir Gachabayov, MD, PhD, Ryan Bendl, DO, FACS, FASCRS, Rifat Latifi, MD, FACS, FICS, The Felicien Steichen Professor, Roberto Bergamaschi, MD, PhD, FRCS, FASCRS, FACS, Professor of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY
1377
This review aims to provide succinct insight into the past, present and near-future of right colon resection. The history of right colon resection as well as the evolution of a laparoscopic approach are described. Standardization of the surgical technique, indications for medial-to-lateral and lateral-to medial mobilization, D2 and D3 lymphadenectomy, iso-peristaltic and antiperistaltic anastomotic configurations, intracorporeal and extracorporeal anastomosis, totally stapled and stapled handsewn techniques, laparoscopic and robotic suturing, mucosa eversion and inversion, and specimen extraction sites are discussed. In addition, totally intracorporeal robotic right colectomy for cancer is described. This review concludes that, whether it is hindered or assisted, gasless or “con gas”, multiple- or single-port, extra- or intracorporeal, iso- or anti-peristaltic, right colon resection is still evolving.
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Robotic Sphincter-Saving Total Mesorectal Excision for Rectal Cancer Treatment: A Single-Surgeon Experience in 103 Consecutive Male Patients
Vusal Aliyev, MD, Group Florence Nightingale Hospital, Istanbul, Turkey, Handan Tokmak, MD, Associate Professor, Suha Goksel, MD, Professor of Pathology, Maslak Acibadem Hospital, Istanbul, Turkey, Hakan Kaya, MD, Maslak Acibadem Hospital, Istanbul, Turkey, Koray Guven, MD, Professor of Radiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey, Baris Bakir, MD, Professor of Radiology, Istanbul University Faculty of Medicine, Istanbul, Turkey, Oktar Asoglu, MD, Professor of Surgery, Bosphorus Clinical Research Academy,, Istanbul, Turkey
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Background: A robotic surgical approach provides advantages compared to laparoscopy in male patients with mid- and low-lying rectal cancer located in the narrow pelvic space. The aim of this report is to present a single-surgeon experience with robotic sphincter-saving total mesorectal excision of rectal cancer in male patients.
Methods: A series of 103 consecutive male patients who underwent robotic rectal surgery between January 2012 and June 2019 were analyzed retrospectively in terms of demographics, histopathological data, and surgical and oncological outcomes.
Results: All of the patients underwent robotic sphincter-saving resection: 76 (73.8%) underwent low-anterior resection and 27 (26.2%) underwent intersphincteric resection with colo-anal anastomosis. There was no conversion. The median distal resection margin of the operative specimen was 3 (0.2-7) cm. The circumferential resection margin was positive in 3 (2.91%) cases. The median number of retrieved lymph nodes was 22 (18-42). The median hospital stay was 4 (3-16) days. Whereas the overall morbidity was 13%, there was no in-hospital or 30-day mortality. The median length of follow-up was 48 (9-80) months. The 5-year overall survival rate was 87%. The 5-year disease-free survival rate was 84%. Local and distant recurrence rates were 3.8% and 5.82%, respectively.
Conclusions: In male patients with rectal cancer, a robotic approach is a promising alternative and is expected to overcome the low penetration rate of laparoscopy in this field.
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Evolution of the Circular Stapler in Rectal Cancer Surgery
Agon Kajmolli, MD, Matthew McGuirk, MD, Mahir Gachabayov, MD, PhD, Roberto Bergamaschi, MD, PhD, Professor of Surgery and Chief, Rifat Latifi, MD, MD, FACS, FICS, The Felicien Steichen Professor and Chairman of Surgery, Director, Westchester Medical Center, Valhalla, NY, New York Medical College, School of Medicine, Valhalla, NY
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The circular stapler has played a critical role in fashioning colorectal anastomoses following low anterior resection for rectal cancer. One of the greatest benefits of the circular stapler has been the feasibility of constructing ultra-low anastomoses, thereby decreasing permanent colostomy rates. A notable US innovation to the original design was the addition of disposable cartridges of various sizes, which greatly decreased assembly time and made the instrument more versatile. Another important modification was the ability to detach the anvil from the stapler shaft. This markedly simplified the construction of anastomoses by negating the need for a double purse-string and avoiding an open rectal stump. An additional modification to facilitate transanal stapler extraction was the tilted-top anvil, which flipped parallel to the shaft once the stapler was fired. The circular stapler continues to evolve while maintaining the basic elements of Hültl’s brilliant concept from over a century ago.
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Should Surgeons Evaluate the Anatomy of Drummond Marginal Artery and Riolan’s Arch Preoperatively?
Emrah Karatay, MD, Istanbul Kartal Dr. Lufti Kirdar City Hospital, Istanbul, Turkey, Baki Ekci, MD, Professor of Surgery, Halic University, Mirkhalig Javadov, MD, Assistant Professor of Surgery, Yeditepe University Hospital1334
Introduction: The Drummond marginal artery and the Riolan’s arch are important links between the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA), which provide collateral flow in case of arterial occlusion or significant stenosis. The Riolan’s arch is important in colorectal surgery since it allows for vascularization of the descending colon by the SMA after ligation of the IMA at its origin, especially in cancer patients. In this study, we aimed to evaluate the presence of the Drummond marginal artery and the Riolan’s arch. In addition, we assessed anatomic variants of the middle colic artery (MCA) and classified the anatomic relationships between SMA and SMV.
Materials and Methods: Following screening, 115 abdominal CT scans were included in the study. For all cases, the presence of the Drummond marginal artery and the Riolan’s arch, the first diameter of these arterial structures at their origins, the first emerging diameter and anatomic variants of the MCA, and the anatomic relationships between SMA and SMV were evaluated.
Results: Drummond marginal artery was present in all participants (100%). The Riolan’s arch was observed in 27.8% of all cases and was higher than in other studies. This can be related to the focus of this arch. In addition, we did not find any similar study in the literature that evaluated MCA origin types, SMA-SMV variants with the presence of the Drummond artery and the Riolan’s arch, and the first emerging diameters of vascular structures, such as the Drummond marginal artery, the Riolan’s arch, and MCA.
Conclusion: Evaluating and stating whether the Drummond marginal artery and the Riolan’s arch are seen in thin section abdominal computed tomography (CT) and CT angiographies preoperatively may help in planning appropriate resections and can reduce unwanted postoperative morbidity.
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Stercoraceous transmission of SARS-CoV-2 (Coronavirus)
EDITORIAL
Daniel Moritz Felsenreich, MD, PhD, Hanjoo Lee, MD, Mahir Gachabayov, PhD, Research Scholar, Anila Kumar, DO, Roberto Bergamaschi, MD, PhD, FRCS, FASCRS, FACS, Professor of Surgery and Chief, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
1338
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A Multicenter Prospective Non-Randomized Study Comparing Ferguson Hemorrhoidectomy and Transanal Hemorrhoidal Dearterialization for Prolapsed, Nonincarcerated, Reducible Hemorrhoids: A Study Protocol
Mahir Gachabayov, MD, PhD, Geena George, MPH, Agon Kajmolli, MD, Matthew McGuirk, MD, Westchester Medical Center, New York Medical College, Valhalla, NY George Angelos, MD, Stony Brook University, Roberto Bergamaschi, MD, PhD, FRCS, FASCRS, FACS, Professor of Surgery and Chief, Westchester Medical Center, New York Medical College, Valhalla, NY
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Introduction: Current evidence suggests that transanal hemorrhoidal dearterialization (THD) is associated with less postoperative pain and faster recovery than Ferguson hemorrhoidectomy. However, there is some uncertainty regarding the durability of the therapeutic effect in terms of recurrent disease.
Objective and significance: The aim of this study will be to evaluate the outcome of THD compared to Ferguson hemorrhoidectomy in terms of recurrence rate at 1-year follow-up.
Methods: This is a multicenter, parallel-arm, non-randomized prospective study comparing Ferguson hemorrhoidectomy and THD in terms of recurrence rate at one year. The primary endpoint is recurrence rate at one year defined as prolapsing internal hemorrhoids at physical examination. Secondary endpoints include the following postoperative complications: urinary retention, constipation (requiring laxative or emergency room visit), dysuria, pruritis ani, anal pain, anal stenosis, unhealed wound, fissure, fecal urgency, and flatus or stool incontinence. Adults older than 18 years with prolapsed, non-incarcerated, reducible hemorrhoids in at least 3 columns at physical examination will be included in one of the study arms: Ferguson hemorrhoidectomy and THD. Surgeons with proven expertise in hemorrhoids surgery will enroll patients undergoing Ferguson hemorrhoidectomy and THD (not both). Each participating surgeon will enroll a maximum of 10 patients.
Ethics and Dissemination: This study was approved by the Institutional Review Boards of Stony Brook University (previously) and New York Medical College (currently), and registered in ClinicalTrials.gov (NCT03245086). The findings of the study will be published in a peer-reviewed journal.
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