Laparoskopi%20vid%20akut%20och%20elektiv%20tarmkirurgi%20Kirubdagarna%20i%20S - PowerPoint PPT Presentation

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Laparoskopi%20vid%20akut%20och%20elektiv%20tarmkirurgi%20Kirubdagarna%20i%20S

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Title: Rubrik, Arial Bold 32 pt Author: Vivi-Ann Persson Last modified by: Ulf Kressner Created Date: 9/23/2005 2:50:53 PM Document presentation format – PowerPoint PPT presentation

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Title: Laparoskopi%20vid%20akut%20och%20elektiv%20tarmkirurgi%20Kirubdagarna%20i%20S


1
Laparoskopi vid akut och elektiv
tarmkirurgiKirubdagarna i Södertälje maj 2014
2

LAPAROSKOPISK KOLOREKTAL KIRURGI I SVERIGE
20102012

3
Lap kolonresektion för cancer
  • andel lap konv
  • () ()
  • 2010 6,0 17
  • 2011 9,0 21
  • 2012 12,2 19

4
Sverige kolon 2010-2012


5
Lap kolon regioner 2012
  • Andel Konv.
  • Södra 4 (19/517) 26
  • Sydöstra 11 (37/333) 19
  • Västra 12 (62/524) 24
  • Stockholm/Gotland 23 (109/479) 19
  • Uppsala/Örebro 18 (99/563) 14
  • Norra 0 (0/246) -

6
2012
7
gt30 lap kolon 2012
  • Torsby 90 (9/10)
  • Hudiksvall 57 (12/21)
  • Lindesberg 55 (6/11)
  • Danderyd 53 (50/95)
  • Ersta 46 (41/89)
  • Örebro 33 (21/63)
  • Skövde 31 (19/61)
  • Uppsala 30 (19/64)

8
Lap rektumresektion för cancer
  • andel lap konv
  • () ()
  • 2010 5,5 17
  • 2011 7,9 22
  • 2012 11,4 19

9
Sverige rektum 2010-2012


10
Lap rektum regioner 2012
  • andel konv
  • Södra 3 (7/255) 29
  • Sydöstra 17 (25/150) 28
  • Västra 26 (73/278) 16
  • Stockholm/Gotland 12 (30/250) 13
  • Uppsala/Örebro 7 (22/313) 23
  • Norra 0 (0/128) -

11
gt30 lap rektum 2012
  • Trollhättan(NÄL) 75 (36/48)
  • Skövde 58 (19/33)
  • Örebro 42 (20/48)
  • Danderyd 35 (13/37)
  • Linköping 32 (15/47)

12
Sammanfattning
  • Andelen lap kolon rektum
  • är lÃ¥g men ökar
  • Skillnader mellan regionerna
  • Acceptabel konverteringsfrekvens

13
Sammanfattning
  • Andelen lap kolon rektum
  • är lÃ¥g men ökar
  • Skillnader mellan regionerna
  • Acceptabel konverteringsfrekvens

14
Laparoskopi vid akut tarmkirurgi
  • Appendicit
  • Cholecystit
  • Perforerat ulcus
  • Adherensileus

15
Laparoskopi vid akut tarmkirurgi
  • 1/3 av akut kirurgi kolorektal kirurgi
  • Akut divertikulit lavage drän
  • Komplikationer till elektiv kirurgi
  • Akut IBD kirurgi

Myers et al, BJS 2008 Kirsthein et al, JGS 2008
16
Systematic review of emergency laparoscopic
colorectal resection
British Journal of SurgeryVolume 101, Issue 1,
pages e126-e133, 28 NOV 2013
17
Systematic review of emergency laparoscopic
colorectal resection
11 case series 11 comparative studies
comparing emergency LS versus OS. No randomized
clinical trials were identified. All
comparative series were retrospective
case-matched series, with matching based on age
and sex.
British Journal of SurgeryVolume 101, Issue 1,
pages e126-e133, 28 NOV 2013
18
Systematic review of emergency laparoscopic
colorectal resection
Eligibility criteria outcomes of laparoscopic
colorectal resections in the acute or emergency
setting in adults. Exclusion laparoscopic
management of acute small bowel
obstruction laparoscopy and peritoneal lavage
alone for colorectal pathology diagnostic
laparoscopy
British Journal of SurgeryVolume 101, Issue 1,
pages e126-e133, 28 NOV 2013
19
Systematic review of emergency laparoscopic
colorectal resection
5557 pt 932 laparoscopic 4625 open
British Journal of SurgeryVolume 101, Issue 1,
pages e126-e133, 28 NOV 2013
20
Systematic review of emergency laparoscopic
colorectal resection
Diagnoser Divertikulit UC Crohn Kolorektal
cancer Sigmoideum Volvulus
British Journal of SurgeryVolume 101, Issue 1,
pages e126-e133, 28 NOV 2013
21
Systematic review of emergency laparoscopic
colorectal resection
Results LS OS Op time(min) 184 (63444)
148 (61231) Length of stay 10 (323)
15 (633) Coversion () 3(0-13) Complication
rate() 29 48

22
Systematic review of emergency laparoscopic
colorectal resection
Conclusion Emergency laparoscopic colorectal
resection, where technically feasible, has better
short-term outcomes than open resection.
British Journal of SurgeryVolme 101, Issue 1,
pages e126-e133, 28 NOV 2013
23
Laparoskopisk kolorektal kirurgi
24
Laparoscopic surgery for colon and rectal cancer
- current evidence
  • COLOR I and II
  • Colon and rectal cancer EUROPE
  • CLASICC
  • Colon and rectal cancer UK
  • COST
  • Colon cancer USA
  • Cohrane 2005, 2008

25
Laparoskopisk kolorektal kirurgi Snabbare
normalisering av tarmfunktion Snabbare
återhämtning Mindre analgetikabehov Kortare
vårdtid
26
Anatomiska landmärken vid dissektion av vänster
kolon
  • Inferior mesenteric vein IMV
  • Inferior mesenteric artery - IMA
  • Vänster uretär
  • Eagle sign

27
Medial to lateral view in left-sided resections
Trocars Optical Operating Retractors
15-25 Trendelenburg 5-10 right tilt
2nd ass, camera
Monitor
First assistant
Surgeon
Nurse
Monitor
28
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29
Hur man på ett bra sätt kommer igång.
  • Tippa patienten samt rotera vänster sida upp
  • För omentet uppÃ¥t
  • Lyft tunntarmen med försiktighet
  • Lyft upp sigmoideum uppÃ¥t - lateralt
  • Ev sut uterus och kolon mot bukväggen

30
Laparoskopisk teknik vä kolon mobilisering
31
Hur man på ett bra sätt kommer igång.(2)
  • Inscidera peritoneum alldeles vid promontorium
  • Dissekera nära kärlet
  • Obs! nerverna vid promontorium
  • Dissekera mellan fascieplanen
  • Visualisera vänster uretär

32
Eagle sign
33
Medial to lateral view in right-sided resections
Trocars Optical Operating Retractors
Monitor
Surgeon
2nd ass, camera
Nurse
Monitor
34
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35
Vascular anatomy right hemicolectomy
  • Ileocolic artery - constant vessel
  • Right colic artery - rare! 13
  • Middle colic artery - complex system of
    different vessels

36
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37
Exposure
  • The assistent pull on caecum
  • Incise peritoneal sheet just under the ileocolic
    artery
  • Dissect close to the artery
  • Be aware of the duodenum and the pancreatic head

38
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39
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40
Sammanfattning
  • Standardisering av stegen
  • Medial till lateral dissektion
  • Starta med enkla fall selektera noggrannt
  • Konvertera tidigt!

41
Tack!
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