Alvaro Garcia-Granero

Application of three-dimensional printing in laparoscopic dissection to facilitate D3-lymphadenectomy for right colon cancer

Complete mesocolic excision (CME) has been recently popularized in an attempt to reduce local recurrences following curative right colon cancer surgery. CME combines the concept of total mesorectal excision, which currently represents the gold standard for rectal cancer surgery, with central ligation and removal of apical nodes (D3-lymphadenectomy), routinely recommended in Japanese guidelines for T3/T4 tumours irrespective of N status and in selected T2 patients [1, 2]. Dissection of the gastrocolic trunk of Henle (GCTH) and that of the surgical trunk of Gillot (STG) are crucial steps to achieve a proper D3-lymphadenectomy. Anatomical location, vascular variability and fragility of vessels in this area increase the risk of intraoperative bleeding from the superior mesenteric vein, which might be responsible for conversion during laparoscopic surgery. Preoperative vascular imaging studies can reduce bleeding and complications in laparoscopic surgery [1]. The role of preoperative three-dimensional (3D) printing in colorectal surgery needs to be assessed. We describe the application of 3D-printing in planning laparoscopic dissection of the GCTH and STG during D3-lymphadenectomy.

The use of an endostapler in the treatment of supralevator abscess of intersphincteric origin

This technical note describes the use of an endostapler for the definitive treatment of supralevator abscess upward from an intersphincteric origin.

Resultados de la cirugía de la recidiva pélvica de cáncer de recto. Experiencia en un centro de referencia

INTRODUCTION The only curative treatment of pelvic recurrence of rectal cancer is radical resection. The aim of this paper is to analyze our experience in surgery for local recurrence of rectal cancer. METHODS We performed a descriptive retrospective analysis of patients treated with curative intent for local recurrence of rectal cancer from May 2000 to January 2014. The presence of resectable liver or lung metastases was not an exclusion criterion. The descriptive results, overall survival and disease free survival are presented. RESULTS A total of 35 patients were included. In 18 patients an abdomino-perineal resection of the remaining rectum was performed. Two of them included excision of lower sacral vertebrae, while in 17 patients, sphincter sparing surgery was performed. The most frequent postoperative complications were pelvic collection and postoperative ileus. Seven patients required reoperation and one patient died. Overall survival at one year was 91.2%, at 2 years 75.6% and at 5 years 37%. CONCLUSIONS Local recurrence of rectal cancer is a disease with high curability rate. The only curative option is radical surgery, with acceptable mortality.

Inferior mesenteric vein as initial landmark for laparoscopic medial to lateral dissection of descending colon - video vignette

The root of the inferior mesenteric artery is an important area where autonomic nerves are close by, the dissection can be hard and laborious in order to avoid nerve damage; and the separation of mesocolon and retroperitoneum in this area can sometimes be difficult. The inferior mesenteric vein dissection is an alternative option as the first step during medial to lateral approach of laparoscopic left mesocolon mobilisation, as we have shown in this video based on two real cases and two anatomical cadaveric dissection. This article is protected by copyright. All rights reserved.

Preoperative surgical planning based on cadaver simulation and 3D imaging for a retrorectal tumour: description and video demonstration

Retrorectal or presacral tumours include rare lesions growing into the retrorectal space. A recent systematic review with 82 patients found that these tumours are more frequent in women, mostly occurring around 40 years of age. In up to 95% of reported cases the mass was benign, schwannoma accounting for 33% of them [1]. Indications for surgery include compression of surrounding structures, symptoms, and features suspicious of malignancy or malignant transformation. According to tumour and patient features, different surgical approaches have been proposed. Minimally invasive surgery can be safely performed [1, 2], but no criteria have been agreed upon for selecting patients suitable for such an approach. It has been reported that there are no differences in the median size of the tumours between those removed by open vs minimally invasive surgery. However, solid or very large masses and a narrow pelvis could preclude minimally invasive approaches [1]. We describe our approach to retrorectal tumours, based on three-dimensional (3D) imaging reconstruction combined with preoperative strategy planning with a cadaver simulation.

Surgical anatomy of the deep postanal space and the re-modified Hanley procedure - a video vignette

Deep postanal abscess (DPA) comprises less than 15% of all types of anorectal abscess (1). The deep postanal space communicates on either side with the ischioanal fossa providing a pathway for abscess extension. A horseshoe extension with bilateral involvement of both ischioanal fossae secondary to a trans-sphincteric fistula is the most severe manifestation of this condition(2). This article is protected by copyright. All rights reserved.

Surgical anatomy of D3 lymphadenectomy in right colon cancer, gastrocolic trunk of Henle and surgical trunk of Gillot - a video vignette

Complete mesocolon excision (CME) and D3 lymphadenectomy(D3-L) necessitate a high tie of mesenteric vessels (1,2). D3-L highlights lymph nodes dissection of Surgical Trunk of Gillot (STG) and Gastrocolic Trunk of Henle (GCTH) areas (3). Laparoscopic dissection of these areas is associated with intraoperative bleeding, which may culminate in a fatal outcome(4). The STG is the adipose tissue between the ileocolic vein and the GCTH. GCTH is a venous trunk consisting of the right gastroepiploic vein, anterior superior pancreatic-duodenal vein and the superior right colic vein (5). This article is protected by copyright. All rights reserved.

Anatomical strategy for complete laparoscopic mesocolic excision for splenic flexure colonic cancer - a video vignette

A laparoscopic approach to complete mesocolic excision (CME) for splenic flexure colonic tumors (SFCT) is less frequently performed as it presents a higher degree of difficulty tan other colonic resections and is accompanied by associated intraoperative complications (1). Furthermore the variation of lymphovascular structures has hindered standardisation of surgery for SFCT (2). Using both cadaveric simulation and video examples from a resected T4 adenocarcinoma, the key technical points for a laparoscopic complete mesocolic excision for a SFCT are demonstrated. This article is protected by copyright. All rights reserved.