2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
cedures (56).
Mean operating time was 243 minutes, and conversion rate
was 14.7%.
Post operative complications included wound infection in
16.9% and anastomotic leak in 5.2% of the cases. Re-operation
was required in 9.1%, and overall post-operative mortality,
including emergency procedures, was 3.2%.
For the group operated for cancer until 2001, actual 3-year survival
for all stages was 71%. Node positive patients had 73% 3-
year survival rate.
Conclusions: Laparoscopic colorectal surgery allows for
acceptable short term and oncologic outcome, comparable to
that achieved by open surgery.
P135–Colorectal/Intestinal Surgery
TOTALLY LAPAROSCOPIC COLON RESECTION WITH INTRA-
CORPOREAL ANASTOMOSIS FOR BENIGN AND MALIGNANT
DISEASE, Bethany Sacks MD, S G Mattar MD,G Eid MD,L Velcu
MD,T Rogula MD,P Thodiyil MD,J Collins MD,F Qureshi MD,P
Yenumula MD,B Lane MD,R C Ramanathan MD,P R Schauer
MD, Magee-Womens Hospital, University of Pittsburgh Medical
Center
Introduction/Objective: The advantages of intracorporeal anastomotic
principles include optimal exposure, reduced bowel
manipulation, and superior anastomotic integrity in patients
with shortened mesentery or thick abdominal wall. We report
our experience with colon resections for both benign and
malignant disease using a totally laparoscopic approach utilizing
an intracorporeal anastomosis.
Methods: 57 patients underwent laparoscopic colon resections
with an intracorporeal bowel anastomosis from August 1996 to
July 2004. Information on the following were collected for each
patient: age, sex, indication for surgery, procedure performed,
concurrent procedures, complications, length of stay, pathology,
number of nodes, and length of disease-free follow-up.
Results: Of the 57 patients, 30 were female (53%), with an age
range of 25-88 years (median 69). Indications for surgery
included polyps (52.6%), adenocarcinoma (21.1%), diverticular
disease (17.5%), and other benign indications (8.8%). Of the
colonic polyps, 11 contained adenocarcinoma, 7 contained
dysplasia, and 9 were unresectable endoscopically. The most
common procedures performed were right hemicolectomy
(46%), sigmoidectomy (26%), left hemicolectomy (9%) and low
anterior resection (9%). When operating for malignancy, the
average number of lymph nodes removed was 10.8 (range 1-
39). The median length of stay was 4.0 days (range 2-18).
There were three intraoperative complications and no major
complications. Long-term complications included five extraction
site hernias (8.8%) and four patients had small bowel
obstruction. There were three intraabdominal recurrences
(5.3%), but no port site or wound recurrences.
Conclusions: Laparoscopic colon resection with intracorporeal
anastomosis is a safe and effective treatment for both benign
and malignant disease.
P136–Colorectal/Intestinal Surgery
THE LEARNING CURVE OF 100 LAPAROSCOPIC COLORECTAL
RESECTIONS: TWO COMMUNITY SURGEONS? EXPERIENCE,
Herawaty Sebajang MD, Laurent Biertho MD,Mehran Anvari
PhD,Susan Hegge MD,Craig McKinley MD, Centre for Minimal
Access Surgery, McMaster University Hamilton Ontario
Canada; North Bay District Hospital, North Bay Ontario Canada
PURPOSE: The learning curve for laparoscopic colorectal surgery
has been questioned. The purpose of this article is to
assess the learning curve and steps taken by two community
surgeons who have created a laparoscopic colorectal surgery
program in their local hospital.
METHODS: Between October 2000 and December 2003, 100
laparoscopic colorectal resections were performed for benign
and malignant disease at the North Bay District Hospital, a 200
bed community hospital located 400 km away from the nearest
tertiary care center. All cases were performed by two community
surgeons with no formal advanced laparoscopic fellowship.
We have evaluated the changes in patient outcome during
the two surgeons? learning curve.
RESULTS: During the initial 50 cases, the indication for laparoscopic
colorectal surgery was mostly benign disease and the
primary surgeon was assisted by another general surgeon.
Initially, both surgeons attended laparoscopic colorectal surgery
courses. During the last 50 cases, a wider range of procedures
was performed and telementoring or telerobotic assistance
was used selectively. The learning curve had an impact
on the operating time as well as the conversion rate.
CONCLUSION: A laparoscopic colorectal surgery program can
be safely developed in a community hospital. Laparoscopic
work courses, telementoring, telerobotic assistance, dedicated
nursing staff and appropriate instrument acquisition are
important factors that minimize complications during the
learning curve.
P137–Colorectal/Intestinal Surgery
A SURVEY OF LAPAROSCOPIC SURGERY FOR COLORECTAL
CANCER IN JAPAN, Mitsugu Sekimoto MD, Hirofumi
Yamamoto MD,Masataka Ikeda MD,Ichiro Takemasa MD,Rei
Suzuki MD,Shuji Takiguchi MD,Morito Monden MD,Tetsuichiro
Muto MD, Department of Surgery and Clinical Oncology,
Osaka University, Japanese Society for Cancer of the Colon
and Rectum
Aim) Increasing laparoscopic resections of colorectal cancer
(LC) are performing in Japan. Results of survey of LC in Japan
were reported. Method and Result) The survey was performed
on the home page of the organizer of 60th Japanese Society
for Cancer of the Colon and Rectum(JSCCR) meeting in
January, 2004. The questionnaires referred to the experiences
and points of view on LC of Japanese colorectal surgeons. A
total of 110 colorectal surgeons completed the questionnaire.
Ninety one of them had experiences of LC, and 19 did not.
Most surgeons performing LC indicated LC for curative resection
of advanced cancer. Eighty one thought that LC was less
invasive than open surgery. Fifty nine thought that LC had
some insufficient points regarding the accuracy of the procedures,
such as insufficient lymph node dissection and/ or
resection margin. Fifty three surgeons answered that LC did
give no merits to the hospitals. Income increased only in 16
hospitals. Most of the nineteen surgeons who did not perform
LC, answered that they would start performing LC when they
got an evidence of the superiority of LC over conventional surgery.
Conclusion) Many Japanese colorectal surgeons indicated
LC for advanced cancer. Although most surgeons agreed
regarding the less invasiveness of LC, more than half of them
had doubts about the accuracy of the operation.
P138–Colorectal/Intestinal Surgery
LAPAROSCOPIC APPENDECTOMY: LOOP LIGATION OR ENDO-
SCOPIC STAPLING? A COMPARISON OF TWO TECHNIQUES,
Thomas P Stites MD, Jon C Gould MD,Charles P Heise MD,
University of Wisconsin, Madison
Introduction: Several methods of laparoscopic appendectomy
have been described, yet few studies compare the outcome of
different techniques. Two methods predominate at our institution:
1) endoscopic stapling of the appendix and mesoappendix
and 2) ultrasonic division of the mesoappendix with endoscopic
loop ligation of the appendix. It is not known whether
the technique utilized contributes to post-operative abscess
formation.
Methods: We hypothesized that endoscopic loop ligation is
associated with an increased rate of post-operative, intraabdominal
abscess formation. This is a retrospective review of
consecutive laparoscopic appendectomies performed over the
last 4 years for presumed acute appendicitis at a single hospital
by attending surgeons with junior level assistants. The primary
outcome measured was post-operative, intra-abdominal
abscess formation. Outcomes were stratified by operative findings
and comparisons made by the Fisher?s exact test.
Results: This review identified 724 laparoscopic appendec-
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