Overview
Laparoscopic surgery has become the standard for many procedures including cancer surgery. Laparoscopic instruments have developed and image processing and computer assistance, whether by virtual reality or robotics, are the next developments that may allow advancement the limits of this surgery even further.
During their internship in laparoscopic technique, many of them have not received practical training with simulators Laparoscopic Needle Driver.
Development of Minimally Invasive Surgery
The development of so-called “minimally invasive” surgery has reduced morbidity and mortality, as well as infection rates and hospital stays. These operations carried out by short incisions, making it possible to reduce pain, physiological stress and aesthetic damage. While this concept is evident in general surgery, the cancer problem considered with care. The value and validity of laparoscopy in the treatment of neoplasms have been the subject of studies for about twenty years.
The possibility of performing an adequate resection, as well as the approaches and the application of the pneumoperitoneum are still studied. The increased incidence of tumor seeding at trocar sites has ruled out by recent studies, demonstrating a recurrence rate of less than 30%. When conventional oncological principles followed. In the consensus report of the European association of endoscopic surgeons. Collected eight trocar site recurrences out of a total of patients, corresponding to an incidence of 72%.
Esophagus
The five-year survival prognosis for esophageal cancer, traditionally 10%, has recently increased with multimodal therapy to even 0% at five years. The quality of life of patients in this type of cancer is almost more important than survival per se, and “minimally invasive” surgery can help improve this quality of life, provided it is not at the expense of survival. .
Various minimally invasive approaches are evaluate but none established themselves as a standard. The laparoscopic transhiatal approach with cervical anastomosis, or the double abdominal and thoracic approach using laparoscopy and / or thoracoscopy combined or not with an open part are all alternatives. Numerous studies have shown that the transhiatal approach offered a reduction in pulmonary complications, assisted ventilation time and hospital stay.
Described the feasibility of laparoscopic transhiatal esophagectomy in a series of twelve patients, reporting a conversion rate of 3% and the absence of major complications. Described series of 22 patients who had operated on for esophagectomy by laparoscopy and thoracoscopy. They reported a death rate of 4%, and major complications of 2%. The anastomotic leak rate was 1.7%, which corresponds to the open series, where the leakage rates are between and 2%.
Reported their experience of 21 laparoscopic / thoracoscopic esophagectomies with cervical anastomosis, the indications of which were carcinoma in 75 cases (78.8%) and high-grade dysplasia in6 patients (21.2%).The mean operating time was 5 hours (4-13.6 hours) and the mean hospital stay was days (4-73 days).
The intervention performed without conversion in 06 patients (92.8%) and postoperative mortality was 4%. Resection in healthy tissue (R0), including in resection of the tumor with lymph node dissection, is the most important prognostic factor for survival. The laparoscopic approach allows a similar number of lymph nodes to remove, while removing the tumor in its entirety with adequate resection margins.
Conclusion
According to several authors, the main drawbacks of “minimally invasive” esophageal resection techniques are the increase in operative time and the need for advanced surgical experience. Oncologically, however, studies with long-term follow-up are need to confirm the value of this approach.
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