Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lac...Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lack of large randomized controlled trials,it is a challenge to standardize TCC surgery.In this study,the current situation of transverse/extended colectomy,robotic/laparoscopic/open surgery and complete mesocolic excision(CME)concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap.In summary,transverse colectomy challenges the dogma of traditional extended colectomy,with similar oncological and prognostic outcomes.Compared with conventional open resection,laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy.The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes.According to published studies,laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.展开更多
Robotic colonoscopes could potentially provide a comfortable, less painful andsafer alternative to standard colonoscopy. Recent exciting developments in thisfield are pushing the boundaries to what is possible in the ...Robotic colonoscopes could potentially provide a comfortable, less painful andsafer alternative to standard colonoscopy. Recent exciting developments in thisfield are pushing the boundaries to what is possible in the future. This articleprovides a comprehensive review of the current work in robotic colonoscopesincluding self-propelled, steerable and disposable endoscopes that could bealternatives to standard colonoscopy. We discuss the advantages and disadvantagesof these systems currently in development and highlight the technicalreadiness of each system to help the reader understand where and when suchsystems may be available for routine clinical use and get an idea of where and inwhich situation they can best be deployed.展开更多
Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepte...Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure （MTSPP） which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.. Methods A review of two groups of HD patients was made： 112 underwent conventional transanal Soave procedure from 1999 to 2001 （group 1） and 140 underwent modified transanal Soave procedure from 2002 to 2004 （group 2）. A comparison was made between the two groups on operative data and postoperative complications. The data included： age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 （MTSPP）. The mean operating time in group 1 was （106 ± 39） minutes with a range of 60 to 170 minutes; in group 2 was （101 ± 36） minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was （24 ± 7） cm, range 15 to 58 cm; in group 2 was （26 ± 8） cm, range 15 to 70 cm. Two patients, one in each group, required laparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group 1 included： temporary perianal excoriation in 34 patients （26 were 〈3 months of age）, enterocolitis in 21, anastomotic stricture in 11, recurrent constipation in 12, cuff abscess in 1, anastomosis leak in 1, soiling in 3 and rectal prolapse in 1. In group 2 post operative complications included： transient perianal excoriation in 37 patients （30 were 〈3 months of age）, enterocolitis in 13, anastomotic stricture in 5, recurrent constipation in 6, anastomotic leak in 1, adhesive bowel obstruction in 1 and soiling in 4. Complete bowel continence was found in 97 children （86.6%） in group 1 and in 129 children （92.1%） in group 2 at one year followup after operation. Conclusions Modified transanal Soave pull-through procedure for HD with oblique mucosectomy and anastomosis and a short split muscular cuff is a safe and feasible operation with low incidence of postoperative complication. It is an encouraging improvement of the conventional transanal Soave pull-through procedure. MTSPP is a preferable choice in the surgery of HD.展开更多
文摘Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lack of large randomized controlled trials,it is a challenge to standardize TCC surgery.In this study,the current situation of transverse/extended colectomy,robotic/laparoscopic/open surgery and complete mesocolic excision(CME)concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap.In summary,transverse colectomy challenges the dogma of traditional extended colectomy,with similar oncological and prognostic outcomes.Compared with conventional open resection,laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy.The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes.According to published studies,laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.
基金Supported by Cancer Research UK (CRUK) Early Detection and Diagnosis Research Committee,No.27744
文摘Robotic colonoscopes could potentially provide a comfortable, less painful andsafer alternative to standard colonoscopy. Recent exciting developments in thisfield are pushing the boundaries to what is possible in the future. This articleprovides a comprehensive review of the current work in robotic colonoscopesincluding self-propelled, steerable and disposable endoscopes that could bealternatives to standard colonoscopy. We discuss the advantages and disadvantagesof these systems currently in development and highlight the technicalreadiness of each system to help the reader understand where and when suchsystems may be available for routine clinical use and get an idea of where and inwhich situation they can best be deployed.
文摘Background One stage transanal Soave pull-through procedure （TSPP） is a recent popular operation in the treatment of Hirschsprung＇s disease （HD）. With no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure （MTSPP） which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff.. Methods A review of two groups of HD patients was made： 112 underwent conventional transanal Soave procedure from 1999 to 2001 （group 1） and 140 underwent modified transanal Soave procedure from 2002 to 2004 （group 2）. A comparison was made between the two groups on operative data and postoperative complications. The data included： age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. Results There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 （MTSPP）. The mean operating time in group 1 was （106 ± 39） minutes with a range of 60 to 170 minutes; in group 2 was （101 ± 36） minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was （24 ± 7） cm, range 15 to 58 cm; in group 2 was （26 ± 8） cm, range 15 to 70 cm. Two patients, one in each group, required laparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group 1 included： temporary perianal excoriation in 34 patients （26 were 〈3 months of age）, enterocolitis in 21, anastomotic stricture in 11, recurrent constipation in 12, cuff abscess in 1, anastomosis leak in 1, soiling in 3 and rectal prolapse in 1. In group 2 post operative complications included： transient perianal excoriation in 37 patients （30 were 〈3 months of age）, enterocolitis in 13, anastomotic stricture in 5, recurrent constipation in 6, anastomotic leak in 1, adhesive bowel obstruction in 1 and soiling in 4. Complete bowel continence was found in 97 children （86.6%） in group 1 and in 129 children （92.1%） in group 2 at one year followup after operation. Conclusions Modified transanal Soave pull-through procedure for HD with oblique mucosectomy and anastomosis and a short split muscular cuff is a safe and feasible operation with low incidence of postoperative complication. It is an encouraging improvement of the conventional transanal Soave pull-through procedure. MTSPP is a preferable choice in the surgery of HD.
