Laparoscopic-assisted segmental colectomy: early Mayo Clinic experience.

Abstract

OBJECTIVE: To present a large initial series of patients who underwent laparoscopic-assisted segmental colectomy and to assess the feasibility and safety of this procedure. DESIGN: We summarized the clinical outcome data for 122 Mayo Clinic patients selected for laparoscopic-assisted resection of the right, left, or sigmoid colon between 1991 and 1993. MATERIAL AND METHODS: Preexisting factors (such as obesity and prior abdominal operations), indications for surgical treatment, and intraoperative and postoperative complications were analyzed statistically in two groups of patients--those in whom the laparoscopic procedure was completed and those in whom conversion to an open surgical technique was necessary. RESULTS: Laparoscopic-assisted colectomy was successfully completed for a variety of colonic pathologic conditions, including polyps, cancer, and diverticulitis. No operative deaths occurred in this series, and the overall complication rate was low (11%). Patients in whom laparoscopic-assisted colectomy was completed had a more rapid return of bowel function and a briefer hospital stay than did those who required conversion to the traditional open surgical technique. Neither obesity nor previous abdominal surgical procedures precluded successful laparoscopic-assisted colectomy, although the conversion rate to open colectomy was 75% in patients whose weight exceeded 90 kg. CONCLUSION: These findings indicate that laparoscopic-assisted segmental colectomy is safe and feasible, and the procedure may offer patient-related advantages. Oncologic concerns, including recent reports of trocar site recurrences, suggest a cautious approach to its application for resection of colonic cancer.