COLORECTAL and robotic SURGERIES

Slawomir Marecik, MD, FACS, FASCRSAdvocate Lutheran General Hospital, Park Ridge, ILClinical Assistant ProfessorUniversity of Illinois, Chicago, USA

Outline Anatomy Colon cancer Rectal cancer Diverticular disease Inflammatory bowel disease

Crohn’s disease Ulcerative colitis

Anatomy How long is your colon?

Anatomy picture of the colon lymph nodes vessels retroperitoneal part perforations

Anatomy video full colon inside live

Anatomy video of right colon specimen video of left colon and rectum specimen

Colon cancer pictures right colon transverse left colon sigmoid

Colon cancer

Colon cancer type of operations type of anastomosis how the anastomosis is created stapling

Type of anastomosis Hand-sewn Stapled

Linear stapler Circular stapler

Hand-sewn anastomosis

Stapled, linear

Stapled, circular

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

Rectal cancer Anatomy

mesorectum, valves, lymph nodes sphincter

Rectal cancer Level of tumor

Type of operations endoscopic excision local (transanal) excision radical surgery (involving bowel and lymph

nodes) radical surgery with sphincter

ANTERIOR RESECTION

ULTRALOW ANTERIOR RESECTION

LOW ANTERIOR RESECTION

COLOANALPULLTHROUGH

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

Need for proper evaluation endoscopy ultrasound MRI

Types of reconstruction after rectal cancer surgery Straight connection J pouch Side to end

video

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

Video – rectal cancer surgery Total mesorectal excision