講演情報
[AS2-2]High quality procedure of Complete Mesocolic Excision（CME）with Central Vascular Ligation（CVL）in Robotic Colon Surgery
Jung Hoon BAE (Seoul St. Mary's Hospital, The Catholic University of Korea)
CME and CVL is mandatory procedure in Right side colon cancer.
CME as separation of the mesocolic from the parietal plane. The Japanese guideline use the term D3 lymphadenectomy as a concept similar to CME and CVL. D3 lymphadenectomy means that the pericolic LN around the marginal artery, the intermediate LN around the feeding artery, and the main lymph node around the SMA are all dissected. This approach ensures through lymph node removal at all levels, from the area immediately surrounding tumor to the central vascular region. And most studies reported that CME significantly improves oncological outcome.
In the field of colorectal surgery, the advantages of the robotic platform in performing TME（Total Mesorectal Excision）are widely accepted, but, what about CME? Although the several advantages of robotic surgery remain in CME, there are some technical issue. Robotic systems are designed principally to enhance endoscopic manoeuvrability by allowing precise movement, careful dissection and suturing in small confined spaces. However, unlike TME, colectomy using the robot required more effort to create a proper surgical field because the current robotic arm is unsuitable for effective traction of a redundant organ such as the colon, also, there are limitations in using energy devices when performing CVL.
A systematic review which included 21 studies involved more than 50 thousand both side colon cancer patients compared short-term outcomes between Robotic and Laparoscopic surgery. Operation time was significant longer in robotic groups. However, in terms of hospital stay, conversion rate, and number of harvested LNs, robotic colectomy is preferred. How about long term oncological outcomes? Recent meta-analysis which included 5 studies evaluated long term oncological outcomes between robotic and laparoscopic CME. As a result, two different surgical approaches for right colon cancer had similar oncological outcomes. Despite several advantages, the benefits of robotic CME in terms of both short-term and long-term outcomes remain controversial when compared to laparoscopic CME.
Finally, in this session, I would like to introduce my short experience in robotic CME and CVL. Robotic CME is safe and suitable even for junior surgeons who are still overcoming their learning curve.
CME as separation of the mesocolic from the parietal plane. The Japanese guideline use the term D3 lymphadenectomy as a concept similar to CME and CVL. D3 lymphadenectomy means that the pericolic LN around the marginal artery, the intermediate LN around the feeding artery, and the main lymph node around the SMA are all dissected. This approach ensures through lymph node removal at all levels, from the area immediately surrounding tumor to the central vascular region. And most studies reported that CME significantly improves oncological outcome.
In the field of colorectal surgery, the advantages of the robotic platform in performing TME（Total Mesorectal Excision）are widely accepted, but, what about CME? Although the several advantages of robotic surgery remain in CME, there are some technical issue. Robotic systems are designed principally to enhance endoscopic manoeuvrability by allowing precise movement, careful dissection and suturing in small confined spaces. However, unlike TME, colectomy using the robot required more effort to create a proper surgical field because the current robotic arm is unsuitable for effective traction of a redundant organ such as the colon, also, there are limitations in using energy devices when performing CVL.
A systematic review which included 21 studies involved more than 50 thousand both side colon cancer patients compared short-term outcomes between Robotic and Laparoscopic surgery. Operation time was significant longer in robotic groups. However, in terms of hospital stay, conversion rate, and number of harvested LNs, robotic colectomy is preferred. How about long term oncological outcomes? Recent meta-analysis which included 5 studies evaluated long term oncological outcomes between robotic and laparoscopic CME. As a result, two different surgical approaches for right colon cancer had similar oncological outcomes. Despite several advantages, the benefits of robotic CME in terms of both short-term and long-term outcomes remain controversial when compared to laparoscopic CME.
Finally, in this session, I would like to introduce my short experience in robotic CME and CVL. Robotic CME is safe and suitable even for junior surgeons who are still overcoming their learning curve.