1. Laparoscopic Colon Surgery
Dr. Shahram Nazari, MD
SAGES,ELSA
Consultant & Lecturer in Surgery, Department of General and Laparoscopic Surgery, Milad Hospital, Tehran, Iran

2. In 1902 Kelling reported the first successful endoscopic examination of the abdominal cavity.
A few years later Jacobeus advocated the use of this procedure in patients with ascites and for the early diagnosis of malignant lesions.

3. Introduction1
Laparoscopy was initially limited to easy procedures such as cholecystectomy or appendectomy.
Minimally invasive operations were aggressively developed in the 1990s.
Advanced laparoscopic techniques such as antireflux surgery,Heller`s cardio myotomy, CBD explorations.
Laparoscopy was proposed for colorectal surgery as early as 1991.
The widespread use of laparoscopy for the diagnosis and surgical treatment of diseases of the abdomen and pelvis is continuously expanding the scope of laparoscopic procedures.

4. Introduction2
The potential roles for laparoscopy in the treatment of colonic diseases include diagnosis, drainage, diversion, removal of the affected segment, and reconstruction of Hartmann’s procedure, and anastomosis.
However, laparoscopic colorectal surgery remains a challenge because in this procedure the field of action is wider than in other advanced laparoscopic techniques.
The place of laparoscopic-assisted colectomy for colorectal carcinoma is controversial.

5. Benign (non-cancerous) problems which may require surgery 1
Adenomatous Polyps
Diverticular Disease

6. Benign (non-cancerous) problems which may require surgery 2
Familial or Hereditary Polyposis
Inflammatory Bowel Disease
Crohn's Colitis
Ulcerative Colitis

7. Colon Cancer
Colon Cancer

8. Specialized instruments used in laparoscopic surgery of the colon and rectum.

9. Advantages of Laparoscopic Colon Resection
Reduced postoperative pain
More rapid return of normal bowel function
Faster return to solid food
Shorter hospital stay
Faster return to everyday activities
Improved cosmetic results
May result in reduced formation of scar tissue inside the abdomen

10. Aims of this study
To evaluate the feasibility of laparoscopic colectomy.
To evaluate the safety aspects of this approach.

11. Methods Between April 2005 and December 2006
10 consecutive patients underwent LCS in two non academic hospitals by the author.
There were 8 females and 2 males with a mean age of 37.5 (range 22-67) years.

12. Indications for surgery
Diverticulitis (1 patient)
Adenocarcinoma (3 patients)
Obstructing sigmoidocele with prolapse (1 case) without prolapse (2 cases)
Dolichosigmoid (3 patients)

13. Results 1 8 females and 2 males Mean age of 37.5 (range 22-67) years
Mean operation time was 200 Min (range, )
No conversion
No anastomosis leakage
No post-operative death
2 port site hernia in one patient
3 port site infections in 3 patients

14. Results 2
Laparoscopic sigmoidectomy in 5 cases with intracorporeal stapler with colorectal
anastomosis in 4 cases extracorporeal hand-sewn anastomosis in 1 case
Laparoscopic assisted right hemicolectomy (with extracorporeal hand-sewn anastomosis in 1 case)
Laparoscopic assisted left hemicolectomy (with extracorporeal hand-sewn anastomosis in one case)
Rectopexy without sigmoid colon resection(3 cases)

15. Discussion
Recent advances in minimal access surgery of the colon have made laparoscopic or assisted colorectal resection an attractive alternative to open surgery .
Elective laparoscopic or assisted colectomy may be feasible and safe.
In selective cases the complications are few.

16. Complications Specifically attributed to the nature of disease:
Specifically attributed to the laparoscopic technique:
Specifically attributed to the instruments:
Specifically attributed to the Surgeon (Learning Curve)