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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

Slawomir Marecik, MD, FACS, FASCRS

Advocate Lutheran General Hospital, Park Ridge, IL

Clinical Assistant Professor

University of Illinois, Chicago, USA

COLORECTAL and robotic SURGERIES

outline
Outline
  • Anatomy
  • Colon cancer
  • Rectal cancer
  • Diverticular disease
  • Inflammatory bowel disease
    • Crohn’s disease
    • Ulcerative colitis
anatomy
Anatomy
  • How long is your colon?
anatomy1
Anatomy
  • picture of the colon
  • lymph nodes
  • vessels
  • retroperitoneal part
  • perforations
anatomy2
Anatomy
  • video full colon inside live
anatomy3
Anatomy
  • video of right colon specimen
  • video of left colon and rectum specimen
colon cancer
Colon cancer
  • pictures right colon
  • transverse
  • left colon
  • sigmoid
colon cancer2
Colon cancer
  • type of operations
  • type of anastomosis
  • how the anastomosis is created
  • stapling
type of anastomosis
Type of anastomosis
  • Hand-sewn
  • Stapled
    • Linear stapler
    • Circular stapler
colon cancer3
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
Rectal cancer
  • Anatomy
    • mesorectum, valves, lymph nodes
    • sphincter
rectal cancer1
Rectal cancer
  • Level of tumor
slide31

Type of operations

    • endoscopic excision
    • local (transanal) excision
    • radical surgery (involving bowel and lymph nodes)
    • radical surgery with sphincter
slide32

ANTERIOR RESECTION

LOW ANTERIOR RESECTION

ULTRALOW ANTERIOR RESECTION

COLOANAL

PULLTHROUGH

rectal cancer2
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
slide34

Need for proper evaluation

    • endoscopy
    • ultrasound
    • MRI
types of reconstruction after rectal cancer surgery
Types of reconstruction after rectal cancer surgery
  • Straight connection
  • J pouch
  • Side to end
  • video
slide39

preoperative chemoradiation therapy

    • when?
    • how long?
    • why ileostomy?
    • why pouchogram and flex sig?
slide40

Video – rectal cancer surgery

  • Total mesorectal excision