Luglio Gaetano, De Palma Giovanni Domenico, Tarquini Rachele, Giglio Mariano Cesare, Sollazzo Viviana, Esposito Emanuela, Spadarella Emanuela, Peltrini Roberto, Liccardo Filomena, Bucci Luigi
Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy.
Department of Clinical Medicine and Surgery, School of Medicine-Surgical Coloproctology Unit, University of Naples Federico II, Naples, Italy ; Center of Excellence for Technical Innovation in Surgery (CEITC), Italy.
Ann Med Surg (Lond). 2015 Mar 20;4(2):89-94. doi: 10.1016/j.amsu.2015.03.003. eCollection 2015 Jun.
Despite the proven benefits, laparoscopic colorectal surgery is still under utilized among surgeons. A steep learning is one of the causes of its limited adoption. Aim of the study is to determine the feasibility and morbidity rate after laparoscopic colorectal surgery in a single institution, "learning curve" experience, implementing a well standardized operative technique and recovery protocol.
The first 50 patients treated laparoscopically were included. All the procedures were performed by a trainee surgeon, supervised by a consultant surgeon, according to the principle of complete mesocolic excision with central vascular ligation or TME. Patients underwent a fast track recovery programme. Recovery parameters, short-term outcomes, morbidity and mortality have been assessed.
Type of resections: 20 left side resections, 8 right side resections, 14 low anterior resection/TME, 5 total colectomy and IRA, 3 total panproctocolectomy and pouch. Mean operative time: 227 min; mean number of lymph-nodes: 18.7. Conversion rate: 8%. Mean time to flatus: 1.3 days; Mean time to solid stool: 2.3 days. Mean length of hospital stay: 7.2 days. Overall morbidity: 24%; major morbidity (Dindo-Clavien III): 4%. No anastomotic leak, no mortality, no 30-days readmission.
Proper laparoscopic colorectal surgery is safe and leads to excellent results in terms of recovery and short term outcomes, even in a learning curve setting. Key factors for better outcomes and shortening the learning curve seem to be the adoption of a standardized technique and training model along with the strict supervision of an expert colorectal surgeon.
尽管腹腔镜结直肠手术已被证实具有诸多益处，但外科医生对其的应用仍然不足。陡峭的学习曲线是其应用受限的原因之一。本研究的目的是在单一机构中，基于“学习曲线”经验，实施标准化的手术技术和恢复方案，以确定腹腔镜结直肠手术后的可行性和发病率。
纳入前50例接受腹腔镜治疗的患者。所有手术均由一名实习外科医生在顾问外科医生的监督下进行，遵循完整结肠系膜切除并结扎中央血管或直肠系膜全切除术（TME）的原则。患者接受快速康复计划。评估了恢复参数、短期结果、发病率和死亡率。
切除类型：20例左侧切除术，8例右侧切除术，14例低位前切除术/TME，5例全结肠切除术和回肠造口术，3例全直肠系膜切除术和袋状吻合术。平均手术时间：227分钟；平均淋巴结数量：18.7个。中转率：8%。平均排气时间：1.3天；平均排固体粪便时间：2.3天。平均住院时间：7.2天。总体发病率：24%；严重发病率（Dindo-Clavien III级）：4%。无吻合口漏、无死亡、无30天再入院。
即使在学习曲线阶段，正确的腹腔镜结直肠手术也是安全的，并且在恢复和短期结果方面能带来优异的效果。取得更好结果并缩短学习曲线的关键因素似乎是采用标准化技术和培训模式，以及由结直肠外科专家进行严格监督。
