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COLORECTAL and robotic SURGERIES

S l awomir Marecik, MD, FACS, FASCRS Advocate Lutheran General Hospital, Park Ridge, IL Clinical Assistant Professor University of Illinois, Chicago, USA. COLORECTAL and robotic SURGERIES. Outline. Anatomy Colon cancer Rectal cancer Diverticular disease Inflammatory bowel disease

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COLORECTAL and robotic SURGERIES

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  1. Slawomir Marecik, MD, FACS, FASCRS Advocate Lutheran General Hospital, Park Ridge, IL Clinical Assistant Professor University of Illinois, Chicago, USA COLORECTAL and robotic SURGERIES

  2. Outline • Anatomy • Colon cancer • Rectal cancer • Diverticular disease • Inflammatory bowel disease • Crohn’s disease • Ulcerative colitis

  3. Anatomy • How long is your colon?

  4. Anatomy • picture of the colon • lymph nodes • vessels • retroperitoneal part • perforations

  5. Anatomy • video full colon inside live

  6. Anatomy • video of right colon specimen • video of left colon and rectum specimen

  7. Colon cancer • pictures right colon • transverse • left colon • sigmoid

  8. Colon cancer

  9. Colon cancer • type of operations • type of anastomosis • how the anastomosis is created • stapling

  10. Type of anastomosis • Hand-sewn • Stapled • Linear stapler • Circular stapler

  11. Hand-sewn anastomosis

  12. Stapled, linear

  13. Stapled, circular

  14. Colon cancer • When is colostomy needed? • emergency situation when… • bowel is not prepared(bowel prep) • patient has no healing potential • poor nutrition • poor vascular supply • steroids, other severe conditions

  15. Rectal cancer • Anatomy • mesorectum, valves, lymph nodes • sphincter

  16. Rectal cancer • Level of tumor

  17. Type of operations • endoscopic excision • local (transanal) excision • radical surgery (involving bowel and lymph nodes) • radical surgery with sphincter

  18. ANTERIOR RESECTION LOW ANTERIOR RESECTION ULTRALOW ANTERIOR RESECTION COLOANAL PULLTHROUGH

  19. Rectal cancer • When is colostomy needed? • tumor involving the sphincter • poor preoperative continence • When is (protective) ileostomy needed? • low pelvic anastomosis • if radiation was given before surgery

  20. Need for proper evaluation • endoscopy • ultrasound • MRI

  21. Types of reconstruction after rectal cancer surgery • Straight connection • J pouch • Side to end • video

  22. preoperative chemoradiation therapy • when? • how long? • why ileostomy? • why pouchogram and flex sig?

  23. Video – rectal cancer surgery • Total mesorectal excision

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