Results of a Standardized Technique and Postoperative Care Plan for Laparoscopic Sigmoid Colectomy

作者：Anthony J. Senagore, Hans J. Duepree, Conor Patrick Delaney, Karen M. Brady, Victor W. Fazio · 发表于：Diseases of the Colon & Rectum · 年份：2003 · DOI：10.1007/s10350-004-6590-5 · 被引用次数：147 · 研究领域：Colorectal Cancer Surgical Treatments、Diverticular Disease and Complications、Minimally Invasive Surgical Techniques

INTRODUCTION: Laparoscopic sigmoid colectomy has been accepted slowly despite potential advantages because of the perceptions of a steep learning curve and increased operative times and costs. The purpose of this article is to review the outcome of a standardization of all the intraoperative and postoperative processes used in our department for the performance of laparoscopic sigmoid colectomy. METHODS: A consecutive series of patients requiring laparoscopic sigmoid colectomy from March 1999 through December 2001 at the Cleveland Clinic Foundation, Cleveland, Ohio, was analyzed. Patients requiring sigmoid or rectosigmoid resection for all colonic pathologies were included. Criteria for exclusion from an attempted laparoscopic sigmoid colectomy were body mass index >35 and prior major abdominal surgeries (exclusive of hysterectomy, cholecystectomy, or appendectomy). Data collected included age, gender, indication for surgery, American Society of Anesthesiology class, body mass index, operative duration, length of hospital stay, complications, mortality, and 30-day readmission. The operative steps for laparoscopic sigmoid colectomy were as follows: 1) open insertion of the umbilical port; 2) placement of three operating ports; 3) dissection/division of the vascular pedicle after identification of the left ureter; 4) mobilization of the sigmoid and descending colon; 5) rectal mobilization/division; 6) exteriorization of the specimen; and 7) circular stapled anastomosis. Instrum...