ABSTRACT
Introduction .......................................................................................................................... 107 Technique o f Laparoscopic Colon R esection ................................................................. 108 Technique o f Laparoscopic Colon Surgery, Patient Selection .................................... 108 Operative P rocedure ........................................................................................................... 109 Conclusions............................................................................................................................ 110
Laparoscopic bowel surgery began in the early 1980s when Semm reported a large series of laparoscopic appendectomies in Germany.1 The vast majority were for benign disease and, in fact, many of the appendices were histologically nor mal. Although poorly documented, Rich subsequently reported repair o f a bowel perforation in 1989.2 Substantial laparoscopic surgery for benign disease was de scribed by Jacobs, Placencia, Fowler, and Franklin in 1990.3 5 Jacobs performed primarily right hemicolectomies with lateral mobilization followed by exterior ization of the involved segment and an extracorporeal anastomosis. In 1990 Fowler also performed similar procedures for the left colon. The first total intracorporeal resection was performed by Franklin et al in 1990 as well. Laparoscopic oncologic resections were first performed by Phillips and Franklin in 1991 and their pre liminary results were reported in 1992.6
The principles of open surgery for colon malignancies are well known but not well documented. Although each expert refers to a gold standard, the standards are not well published. The principal factors involved in colonic resections for malignancies include a tissue diagnosis of carcinoma with preoperative staging for a definitive oncological procedure. Accepted surgical techniques for colonic malignancies include:
• intraoperative staging • early vascular control and • minimal handling of the tumor.
