En-Bloc Excision of the High-ligated Inferior Mesenteric Vein Pedicle With the Specimen in Patients Undergoing Minimally Invasive and Open Sphincter Saving Rectal Resections for Cancer

Development and Implementation of a Novel Computer-Based Training Module for the Standardization of Splenic Flexure Mobilization

BACKGROUND

Computer-based training modules use various multimedia components such as text, graphics, animation, and videos that can theoretically facilitate the learning process. Splenic flexure mobilization (SFM) is a crucial step for tension-free colorectal/anal anastomosis that can be a technically demanding step. This study is designed to demonstrate our novel training module for SFM with high-vessel ligation during surgery and present the anatomical landmarks and embryological plans for SFM.

MATERIALS AND METHODS

A step-by-step educational video was prepared to standardize and teach the technical steps of the SFM. 3D animation was prepared and cadaveric dissection was performed in a step-by-step manner similar to minimally invasive surgery. This is followed by the laparoscopic technique. Since we have started this modular training program in our department, a consecutive of 100 patients underwent laparoscopic low anterior resection and coloanal anastomosis with covering stoma. Demographics, characteristics, and postoperative outcomes were evaluated.

RESULTS

Surgical anatomical planes and important vascular structures/variations are both shown by 3D animation, cadaveric dissection, and laparoscopic surgery. Out of 100 consecutive cases, there were no mortality, 5 anastomotic leakages 1 of which necessitates reoperation, and 2 splenic injuries which were managed conservatively.

CONCLUSION

This unique educational video module for SFM demonstrates surgical anatomical planes and important vascular structures/variations. The employment and implementation of time-independent multimedia components lead to effective training and can theoretically facilitate the learning process.

Operative and long-term oncological outcomes in patients undergoing robotic versus laparoscopic surgery for rectal cancer

BACKGROUND

This study aimed to compare short- and long-term outcomes after robotic versus laparoscopic approach in patients undergoing curative surgery for rectal cancer.

METHODS

Patients undergoing elective robotic and laparoscopic resection for rectal cancer were included. Perioperative clinical characteristics, postoperative short- and long-term outcomes were compared between groups.

RESULTS

There were 72 and 44 patients in robotic (RG) and laparoscopic (LG) groups respectively. No differences were detected regarding patients' demographics, histopathologic outcomes, conversion rates and 30-day overall postoperative complication rates. Operative time was longer in the RG (341 ± 111.7 vs. 263 ± 97.5 min, p = 0.001) and length of stay was longer in the LG (4.4 ± 1.9 vs. 6.4 ± 2.9 days, p = 0.001). The 5-year overall and disease-free survival rates were similar (97.1% and 94.9%, p = 0.78; 86.2% and 82.7%, p = 0.72) between the groups.

CONCLUSION

This study showed both short and long-term outcomes of a limited number of included patients between the robotic and laparoscopic surgery were similar. However, future studies and randomized trials are necessary to establish these findings.