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Robot‑assisted surgery for rectal cancer using ICG fluorescence angiography
06/2019 MUDr. Daniel Langer; prof. MUDr. Miroslav Ryska, CSc.
Colorectal cancer significantly contributes to the overall oncological burden of the Czech population. Surgical treatment is crucial in multimodal therapeutic approach. Robot-assisted surgery, primarily used for benign conditions, has quickly become an important method of treatment for malignancies. In the treatment of rectal carcinoma, as well as other conditions, the Da Vinci system brings indisputable advantages to the surgeon given the preparation in narrow pelvic space, which significantly contributes to increased safety of the procedure. The Da Vinci system is routinely used in surgical treatment of rectal cancer at many foreign and domestic workplaces. A feared surgical complication with possible fatal consequences for the patient is anastomotic insufficiency. Assessment of tissue perfusion during surgery by fluorescence angiography using indocyanine green in the near-infrared spectrum represents a potential possibility of reducing the frequency of anastomotic leaks.
ENTIRE ARTICLE
Colorectal cancer significantly contributes to the overall oncological burden of the Czech population. Surgical treatment is crucial in multimodal therapeutic approach. Robot-assisted surgery, primarily used for benign conditions, has quickly become an important method of treatment for malignancies. In the treatment of rectal carcinoma, as well as other conditions, the Da Vinci system brings indisputable advantages to the surgeon given the preparation in narrow pelvic space, which significantly contributes to increased safety of the procedure. The Da Vinci system is routinely used in surgical treatment of rectal cancer at many foreign and domestic workplaces. A feared surgical complication with possible fatal consequences for the patient is anastomotic insufficiency. Assessment of tissue perfusion during surgery by fluorescence angiography using indocyanine green in the near-infrared spectrum represents a potential possibility of reducing the frequency of anastomotic leaks.
Some current aspects of colorectal carcinoma surgery
06/2017 Prof. MUDr. Miroslav Ryska, CSc., MUDr. Daniel Langer, MUDr. Jaroslav Kalvach
The authors deal with some current aspects of surgical treatment of colorectal carcinoma. Right-side tumours including coecum, ascending colon, hepatic flexure, transversum and spleen flexure are clinically, biologically and genetically distinct from tumours in the left-handed localization, which includes a descending colon, sigma and rectum. Right-hand localization is a negative prognostic marker, especially for stage III and IV carcinomas. Regardless of right-handed treatment, compared to the left-hand side, it significantly increases the risk of death. There are currently no clear recommendations for indication for the protective ileostomy. Despite some proven benefits, the protective stoma probably only reduces the frequency of clinically manifest anastomotic leakage. The benefit of ileostomy should be carefully considered in the knowledge of possible risks and complications. The rate of anastomotic leakage in colorectal surgery is literally in the range of 1-19 % depending on the type of resection, respectively on anatomical localization of anastomosis. In the case of anastomotic leakage, a crucial role is played by early diagnosis with an active treatment approach which can minimize the consequences of anastomotic leakage. The surgical treatment of the most serious cases of anastomotic leakage plays a key role in surgical treatment, which needs to be repeated in many cases.
ENTIRE ARTICLE
The authors deal with some current aspects of surgical treatment of colorectal carcinoma. Right-side tumours including coecum, ascending colon, hepatic flexure, transversum and spleen flexure are clinically, biologically and genetically distinct from tumours in the left-handed localization, which includes a descending colon, sigma and rectum. Right-hand localization is a negative prognostic marker, especially for stage III and IV carcinomas. Regardless of right-handed treatment, compared to the left-hand side, it significantly increases the risk of death. There are currently no clear recommendations for indication for the protective ileostomy. Despite some proven benefits, the protective stoma probably only reduces the frequency of clinically manifest anastomotic leakage. The benefit of ileostomy should be carefully considered in the knowledge of possible risks and complications. The rate of anastomotic leakage in colorectal surgery is literally in the range of 1-19 % depending on the type of resection, respectively on anatomical localization of anastomosis. In the case of anastomotic leakage, a crucial role is played by early diagnosis with an active treatment approach which can minimize the consequences of anastomotic leakage. The surgical treatment of the most serious cases of anastomotic leakage plays a key role in surgical treatment, which needs to be repeated in many cases.