Browsing by Author "Tomas Larach, Jose"

Now showing 1 - 4 of 4
  • No Thumbnail Available
    Item
    Implementation of intracorporeal anastomosis in laparoscopic right colectomy is safe and associated with a shorter hospital stay
    (2021) Jarry, Cristian; Carcamo, Leonardo; Jose Gonzalez, Juan; Bellolio, Felipe; Miguieles, Rodrigo; Urrejola, Gonzalo; Zuniga, Alvaro; Crovari, Fernando; Elena Molina, Maria; Tomas Larach, Jose
    Reconstruction after laparoscopic right colectomy (LRC) can be achieved by performing an intracorporeal (IA) or an extracorporeal anastomosis (EA). This study aims to assess the safety of implementing IA in LRC, and to compare its perioperative outcomes with EA during an institution's learning curve. Patients undergoing elective LRC with IA or EA in a teaching university hospital between January 2015 and December 2018 were included. Demographic, clinical, perioperative and histopathological data were collated and outcomes investigated. One hundred and twenty-two patients were included; forty-three (35.2%) had an IA. The main indication for surgery was cancer in both groups (83.7% for IA and 79.8% for EA;p = 0.50). Operative time was longer for IA (180 [150-205] versus 150 [120-180] minutes;p < 0.001). A Pfannenstiel incision was used as extraction site in 97.7% of patients receiving an IA; while a midline incision was used in 97.5% of patients having an EA (p < 0.001). Hospital stay was significantly shorter for IA (3 [3, 4] versus 4 [3-6] days;p = 0.003). There were no differences in postoperative complications rates between groups. There was a 4.7% and 3.8% anastomotic leak rate in the IA and EA group, respectively (p = 1). Re-intervention and readmission rates were similar between groups, and there was no mortality during the study period. The implementation of IA in LRC is safe. Despite longer operative times, IA is associated with a shorter hospital stay when compared to EA in the setting of an institution's learning curve.
  • No Thumbnail Available
    Item
    Laparoscopic extended right colectomy with complete mesocolic excision for transverse colon cancer is feasible in the setting of vascular anatomical variations - A video vignette
    (2024) Alvarado, Juan; Montero, Isabella; Besser, Nicolas; Vela, Javier; Bellolio, Felipe; Tomas Larach, Jose
  • No Thumbnail Available
    Item
    Robotic beyond total mesorectal excision surgery for primary and recurrent pelvic malignancy: Feasibility and short-term outcomes
    (2022) Tomas Larach, Jose; Flynn, Julie; Fernando, Diharah; Mohan, Helen; Rajkomar, Amrish; Waters, Peadar S.; Kong, Joseph; McCormick, Jacob J.; Heriot, Alexander G.; Warrier, Satish K.
    Aim To explore the feasibility and safety of robotic beyond total mesorectal excision (TME) surgery for primary and recurrent pelvic malignancy. Methods Patients undergoing robotic beyond TME resections for primary or recurrent pelvic malignancy between July 2015 and July 2021 in a public quaternary and a private tertiary centre were included. Demographic and clinical data were recorded and outcomes analysed. Results Twenty-four patients (50% males) were included, with a median age of 58 (45-70.8) years, and a BMI of 26 (24.3-28.1) kg/m(2). Indication for surgery was rectal adenocarcinoma in nineteen, leiomyosarcoma in two, anal squamous cell carcinoma in one and combined rectal and prostatic adenocarcinoma in two patients. All patients required resection of at least one adjacent pelvic organ including genitourinary structures (n = 23), internal iliac vessels (n = 3) and/or bone (n = 2). Eleven patients had a restorative procedure. Of the 13 nonrestorative cases, nine needed perineal reconstruction with a flap. There was one conversion due to bleeding. The mean operating time was 370 (285-424) min, and the median blood loss was 400 (200-2,000) ml. The median length of stay was 16 (9.3-23.8) days. Fourteen patients (58.3%) had postoperative complications; eight of them (33.3%) were Clavien-Dindo III or more complication. Twenty-three (95.8%) patients had an R0 resection. During a median follow-up of 10 (7-23.5) months, five patients (20.8%) had systemic recurrences. No local recurrences were identified during the study period. Conclusion Implementation of robotic beyond TME surgery for primary and recurrent pelvic malignancy is feasible within a highly specialised setting.
  • No Thumbnail Available
    Item
    Robotic pelvic side-wall dissection and en-bloc excision for locally advanced and recurrent rectal cancer: outcomes on feasibility and safety
    (2022) Lokuhetty, Naradha; Tomas Larach, Jose; Rajkomar, Amrish K. S.; Mohan, Helen; Waters, Peadar S.; Heriot, Alexander G.; Warrier, Satish K.
    Background: Global differences exist in managing lateral pelvic nodes in rectal cancer. Recent studies demonstrate improved local recurrence rates in patients undergoing lateral pelvic lymph node dissections (LPND) in addition to total mesorectal excision (TME) for advanced lower rectal cancer. This study aims to report on the safety and feasibility of the robotic approach in patients undergoing pelvic sidewall lymph node dissection or en-bloc sidewall resection for advanced lower rectal cancer.