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Surgical approach in laparoscopic colorectal cancer surgery
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Medical Faculty of Belgrade, University of Belgrade , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Medical Faculty of Belgrade, University of Belgrade , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Medical Faculty of Belgrade, University of Belgrade , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Surgery Clinic, Clinical Hospital Center Zemun , Belgrade , Serbia
Medical Faculty of Belgrade, University of Belgrade , Belgrade , Serbia
Published: 02.05.2020.
Volume 36, Issue 2 (2020)
pp. 1891-1900;
Abstract
Classical colorectal cancer surgery has been considered the gold standard in the surgical treatment of this disease for decades. Advances in technology and modern medicine have led to the emergence and progression of minimally invasive surgery in the treatment of this malignancy. Surgical procedures differ in relation to the localization of the tumor, as well as in relation to the pathways of hematogenous and lymphogenic spread of the disease. These surgical procedures are applied to the same extent during both classical and laparoscopic surgery. Regarding the indications for the laparoscopic approach in the elective treatment of colorectal cancer, there are no differences compared to classical colorectal surgery. The specificity of the method of work and visualization in laparoscopic colorectal surgery has developed the existence of two characteristic approaches: a) the lateral approach is taken from the classical-open colorectal surgery (“lateral-to medial approach”). It implies that the operation itself begins with the separation and preparation of the adjacent lateral peritoneum from the colon (rectum), and only then is the vascular structures approached from the medial side; b) medial-to-lateral approach, is an approach where after the creation of the pneumoperitoneum and access to the abdomen, the operation begins with the preparation of vascular elements (a.mesentericae inferior and v.mesenterice inferior, for example), and only then access to the lateral associated peritoneum. Most laparoscopic surgeons apply a more medial approach given the numerous advantages of this approach over the medial one that have been proven in comparative analyzes of these two approaches on a large sample of patients. At the same time, these studies did not show statistically significant differences in terms of postoperative complications, mortality, and malignant recurrence rate between the two approaches.
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