Impact of the Standardized Medial-to-Lateral Approach on Outcome of Laparoscopic Colorectal Resection

• Published in: World journal of surgery Vol. 33; no. 10; pp. 2177 - 2182
• Main Authors: Poon, Jensen T. C., Law, Wai-Lun, Fan, Joe K. M., Lo, Oswen S. H.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.10.2009; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Approach Group; Biological and medical sciences; Bowel Function; Cardiac Surgery; Colectomy - methods; Colectomy - standards; Colonic Diseases - surgery; Colorectal Neoplasms - surgery; Female; General aspects; General Surgery; Humans; Laparoscopy; Male; Medial Approach; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Surgery; Thoracic Surgery; Treatment Outcome; Ureter Injury; Vascular Pedicle; Vascular Surgery; Bowel Function; Approach Group; Ureter Injury; Medial Approach; Vascular Pedicle; Medicine; Endoscopic surgery; Prognosis; Treatment; Digestive system; Gut; Rectum; Evolution; Colon; Malignant tumor; Cancer
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-009-0173-5

Background Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique. Methods Data were retrieved from a prospectively collected database on LapCR. The control group included 196 patients operated on from January 2002 to December 2003 and the medial approach group included 224 patients who underwent operations from January 2005 to December 2007. The patient characteristics, operative details, pathology, and surgical outcomes of the two groups were compared. Results The patient demographics, types of operation and pathology did not show any statistically significant difference. The medial approach group was associated with significantly less median blood loss [100 (interquartile range [IQR]: 50–174) ml versus 150 (IQR:100–300) ml; p  < 0.001], shorter hospital stay [4 (IQR: (4–7) versus 7 (5–9) days; p  < 0.001], and more lymph nodes harvested [12 (7–17.5) versus 10 (6–15); p  = 0.001]. Significantly earlier bowel function recovery was observed in the medial approach group. The mortality and complications did not show any difference. Conclusions A standardized medial-to-lateral approach for LapCR is associated with less blood loss, earlier return of bowel function, shorter hospital stay, and increased number of lymph nodes harvested. This should be the preferred approach in LapCR.