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Laparoskopi vid akut och elektiv tarmkirurgi Kirubdagarna i Södertälje maj 2014

Laparoskopi vid akut och elektiv tarmkirurgi Kirubdagarna i Södertälje maj 2014. LAPAROSKOPISK KOLOREKTAL KIRURGI I SVERIGE 2010–2012. Lap kolonresektion för cancer. andel lap konv (%) (%) 2010 6,0 17 2011 9,0 21 2012 12,2 19. Sverige kolon 2010-2012. %.

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Laparoskopi vid akut och elektiv tarmkirurgi Kirubdagarna i Södertälje maj 2014

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

  2. LAPAROSKOPISK KOLOREKTAL KIRURGI I SVERIGE 2010–2012

  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. >30% 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. >30% 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 låg men ökar • Skillnader mellan regionerna • Acceptabel konverteringsfrekvens

  13. Sammanfattning Andelen lap kolon & rektum är låg 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 (63–444) 148 (61–231) Length of stay 10 (3–23) 15 (6–33) 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 15-25 Trendelenburg 5-10 right tilt Trocars: Optical Operating Retractors 2nd ass, camera Monitor First assistant Surgeon Nurse Monitor

  28. Hur man på ett bra sätt kommer igång…. • Tippa patienten samt rotera vänster sida upp • För omentet uppåt • Lyft tunntarmen med försiktighet • Lyft upp sigmoideum uppåt - lateralt • Ev sut uterus och kolon mot bukväggen

  29. Laparoskopisk teknik – vä kolon mobilisering

  30. 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

  31. Eagle sign

  32. Medial to lateral view in right-sided resections Trocars: Optical Operating Retractors Monitor Surgeon 2nd ass, camera Nurse Monitor

  33. Vascular anatomy right hemicolectomy • Ileocolic artery - constant vessel • Right colic artery - rare! 13% • Middle colic artery - complex system of different vessels

  34. 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

  35. Sammanfattning • Standardisering av stegen • Medial till lateral dissektion • Starta med enkla fall – selektera noggrannt • Konvertera tidigt!

  36. Tack!

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