Operations for colon cancer

The operation for colorectal cancer is carried out after appropriate clarification and assessment of the tumor spread locally and throughout the body - with a so-called staging and a possible pretreatment with radiation therapy and /or chemotherapy for advanced diseases, depending on the tumor stage and location of the tumor Classically open through an abdominal incision or minimally invasive laparoscopically using the keyhole technique. The latter technique can be offered to the majority of patients. The following criteria are used to decide which technology is to be used: Stage /size /spread of the tumor, previous operations or previous treatments, general condition and physical fitness of the patient, the patient's request, the surgeon's preference.

Below you can find an exemplary operation report of a minimally invasive laparoscopic right hemicolectomy with CME (complete mesocolic excision) for a malignant tumor (colon cancer, CRC) in the area of ​​the ascending colon, followed by a minimally invasive laparoscopic deep anterior rectal resection with total mesorectal excision (TME) in rectal cancer (rectal cancer in the middle third of the rectum) read:

Minimally invasive right hemicolectomy with CME

Under undisturbed general anesthesia after sterile washing and covering under antibiotic protection, the umbilicus is entered openly, a pneumoperitoneum is applied and the remaining trocars are placed under view. Anti-Trendelenburg storage and left-side storage. The greater omentum is transported under the liver and the small intestine into the left lower abdomen. Exposure of the ileocolic artery and its removal from the superior mesenteric artery. Now, layer-true dissection laterally and cranially while preserving Toldt's fascia. The duodenum is left dorsal. Exposure and removal of a delicate right colic artery. Dissect further medially to the arteria colica media. Sever the gastrocolic ligament, dissect laterally and mobilize the right flexure. Under diaphany, the transverse mesocolon is severed along the arteria colica media and the right branch of the arteria colica media is removed on the right in the sense of a classic hemicolectomy. Representation of the bowel in a circular manner. Mobilization of the right hemicolon and the cecal pole from the lateral side. The terminal ileum is shown in a circular manner around 10 cm orally towards the Valvula Bauhini and the meso bridge between the entrance in the area of ​​the ileocolic artery and the shown terminal ileum is severed. Check whether the entire preparation is fully mobilized. Prepare for the ilotransversostomy functionally end-to-end. Insertion of a holding thread and a gusset seam. Incision of the small intestine and colon. Introducing the two branches of the Echelon linear stacker (blue 60mm magazine). End of the anastomosis antimesenterically. Completion of the anastomosis with a second magazine. Alternatively, this step can be replaced by a continuously sewn V-Loc suture 3.0 and the anastomosis can be completed in this way. The anastomosis is well supplied with blood and free of tension. The blood flow can be displayed not only in white light mode, but also particularly well in NIR (near infrared and laser) mode or in hybrid mode. Excellent blood flow is a basic requirement for smooth anastomotic healing and for a smooth course. Split suture with an absorbable V-Loc suture 3.0. Minilaparotomy, insertion of the wound protection film, insertion of the tear-resistant recovery bag. Recovery of the preparation. Reattaching a pneumoperitoneum. Exact reduction of the small intestine. Reduction of the greater omentum. Hemostasis and flushing. Removal of the trocars under sight, draining of the pneumoperitoneum. Continuous fascia suture of the minilaparotomy, fascia suture of the 12 trocar site. Intracutaneous skin sutures, dry dressing.

Minimally invasive deep anterior rectal resection

Under undisturbed general anesthesia after sterile washing and covering under antibiotic protection, the umbilicus is entered openly, a pneumoperitoneum is applied and the remaining trocars are placed under view. Trendeleburg positioning and tilting to the right. The greater omentum is positioned under the liver after any adhesions have been loosened, the entire small intestine is relocated to the right upper abdomen, the inferior mesenteric vein is exposed at the lower edge of the pancreas and divided with the ligasure. Layer-accurate preparation from medial to lateral while preserving Told's fascia. Now the entire left hemicolon is mobilized up to the left flexure. The greater omentum is dissected from the transverse colon, thus opening the omental bursa. Dissection laterally towards the left flexure. Here the second leaf is still visible and severed. Separation of adhesions to the spleen. The mesocolon is dissected away at the pancreas level while preserving the capsule and thus the flexure is fully mobilized. Representation of the origin of the inferior mesenteric artery. The lymph nodes in this area are exposed and also resected (high tie and low tie lymph nodes). Sever the artery with the ligasure leaving a small stump on the aorta. Lyre-shaped cutting around the pelvic floor. The "holy plane" is now entered at the level of the promontory and a "total mesorectal excision according to Heald" is carried out while preserving the autonomic nerve plexus (plexus hypogastricus). Dissection is made anteriorly along Denonvillier's fascia in a distal direction. The seminal vesicles are preserved. The tumor is located dorsally on the right. It is possible to pass the tumor using the no touch technique and preserving the fascia. Approximately 2cm distal to the tumor, the rectum is exposed in a circular manner and cut with a blue 60mm magazine of the Echelon linear stacker. Further preparation in the proximal direction and complete mobilization of the resected material. Another inspection of the ureter and the arteria and vena testicularis, these are intact. Now the resection limits are determined, the mesos are severed at this point with the ligasure, the colos is severed with a second blue 60mm magazine of the Echelon stapler. Introduction of a tear-proof recovery bag. Insertion of an octoport after minilaparotomy and retrieval of the specimen. Inspection and palpation: the tumor is sufficiently far from the distal resection margin and the mesorectal fascia is completely intact after staining with ink. Now the oral part of the colon is brought out, the colon is prepared, the purse-string sutures are made. Grasp with Ellis clamps and insert the head of the CDH29, knot in and carefully dissect the free end of the colon again, relocate it. Renewed application of the pneumoperitoneum. The stump of the rectum is straightened out, the circular stapler is introduced, the spike is advanced through the row of staples, connection. Exact checking of the rotation, shot of the anastomosis, air sample, the anastomosis is primarily tight, tension-free and well supplied with blood. The blood flow can be displayed not only in white light mode, but also particularly well in NIR (near infrared and laser) mode or in hybrid mode. Excellent blood flow is a basic requirement for smooth anastomotic healing and for a smooth course. Coloscopy: here the anastomosis is inconspicuous, completely without leakage, without any signs of bleeding at about 5 cm from the anus. Due to the good result, a temporary protective ileostomy is dispensed with. Reduction of the small intestine and the greater omentum. Irrigation, hemostasis, removal of all trocars under vision, draining of the pneumoperitoneum, continuous suturing of the minilaparotomy and the 12 trocar site on the right lower abdomen, intracutaneous skin sutures, steristrips, dry bandage.