On 2016 Mar 01, Marco Lotti commented:

Dear Dr. Di Saverio,

thank you for your comment.

The advantages of totally laparoscopic right colectomy with intracorporeal anastomosis over LRC with extracorporeal anastomosis are still under investigation. Preliminary data of a randomized trial show an earlier recovery of bowel function and a lower incidence of postoperative ileus. No differences were observed with respect to length of stay and complication rate <Vignali Andrea et Al. Extracorporeal vs. Intracorporeal Ileocolic Stapled Anastomoses in Laparoscopic Right Colectomy: An Interim Analysis of a Randomized Clinical Trial. Journal of Laparoendoscopic & Advanced Surgical Techniques. February 2016, ahead of print. doi:10.1089/lap.2015.0547.>

We described a technique which is both minimally invasive for patients and an opportunity for low-volume surgeons to embrace laparoscopy as a tool to perform right colectomy with optimal oncological outcomes and a low complication rate. This is all about the importance of surgical education, the novel technique is just the complement.

A definition is literally “a statement that explains the meaning of a word”. I think that the definition of “laparoscopic” is simply “by means of laparoscopy”. But we can also mean “minimally invasive by means of laparoscopy” or “more precise by means of laparoscopy”. Then, we should incorporate the meaning of “right colectomy” with respect to proper resection, acceptable complication rate and optimal oncological outcomes. Finally, we can speculate about the meaning of your term “non-laparoscopic surgeons”.

We called our technique “Laparoscopic Right Colectomy” since it is derived from the original technique of “Laparoscopic Right Colectomy” described by Young Fadok and Nelson [Young-Fadok TM, Nelson H. Laparoscopic right colectomy: five-step procedure. Dis Colon Rectum. 2000 Feb;43(2):267-71]. It is compliant with the SAGES Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer http://www.sages.org/publications/guidelines/guidelines-for-laparoscopic-resection-of-curable-colon-and-rectal-cancer/. Moreover, extracorporeal anastomosis is mentioned in the ASCRS Global Assessment for Laparoscopic Right Hemicolectomy http://www.apdcrs.org/GlobalAssessmentLapRightHemicolectomy.pdf.

If you are still concerned about the definition, please post your comment also to Dr. Tonia Young Fadok and Dr. Heidi Nelson. I think it would be very interesting to know their opinion.

Best regards

On 2016 Feb 28, Salomone Di Saverio commented:

Interesting technique, but let me say that if vascular ligation, resection and anastomosis are performed extra corporeally, this can not be defined a true laparoscopic right colectomy but is rather an half laparoscopic-assisted and half open/hand-assisted right colectomy. Anyway is good and easy reproducible by non-laparoscopic and low volume surgeons, with no experience or not feeling confident in performing intracorporeally mesocolic vascular clipping and both ileum and colonic resection as well as performing intracorporeal anastomosis, or as an initial step during the laparoscopic learning curve. Nonetheless it can NOT be really defined as a "laparoscopic right colectomy" at all; this is just a simple laparoscopic mobilization of the right colon and nothing more.

On 2016 Feb 28, Salomone Di Saverio commented:

Interesting technique, but let me say that if vascular ligation, resection and anastomosis are performed extra corporeally, this can not be defined a true laparoscopic right colectomy but is rather an half laparoscopic-assisted and half open/hand-assisted right colectomy. Anyway is good and easy reproducible by non-laparoscopic and low volume surgeons, with no experience or not feeling confident in performing intracorporeally mesocolic vascular clipping and both ileum and colonic resection as well as performing intracorporeal anastomosis, or as an initial step during the laparoscopic learning curve. Nonetheless it can NOT be really defined as a "laparoscopic right colectomy" at all; this is just a simple laparoscopic mobilization of the right colon and nothing more.

On 2016 Mar 01, Marco Lotti commented:

Dear Dr. Di Saverio,

thank you for your comment.

The advantages of totally laparoscopic right colectomy with intracorporeal anastomosis over LRC with extracorporeal anastomosis are still under investigation. Preliminary data of a randomized trial show an earlier recovery of bowel function and a lower incidence of postoperative ileus. No differences were observed with respect to length of stay and complication rate <Vignali Andrea et Al. Extracorporeal vs. Intracorporeal Ileocolic Stapled Anastomoses in Laparoscopic Right Colectomy: An Interim Analysis of a Randomized Clinical Trial. Journal of Laparoendoscopic & Advanced Surgical Techniques. February 2016, ahead of print. doi:10.1089/lap.2015.0547.>

We described a technique which is both minimally invasive for patients and an opportunity for low-volume surgeons to embrace laparoscopy as a tool to perform right colectomy with optimal oncological outcomes and a low complication rate. This is all about the importance of surgical education, the novel technique is just the complement.

A definition is literally “a statement that explains the meaning of a word”. I think that the definition of “laparoscopic” is simply “by means of laparoscopy”. But we can also mean “minimally invasive by means of laparoscopy” or “more precise by means of laparoscopy”. Then, we should incorporate the meaning of “right colectomy” with respect to proper resection, acceptable complication rate and optimal oncological outcomes. Finally, we can speculate about the meaning of your term “non-laparoscopic surgeons”.

We called our technique “Laparoscopic Right Colectomy” since it is derived from the original technique of “Laparoscopic Right Colectomy” described by Young Fadok and Nelson [Young-Fadok TM, Nelson H. Laparoscopic right colectomy: five-step procedure. Dis Colon Rectum. 2000 Feb;43(2):267-71]. It is compliant with the SAGES Guidelines for Laparoscopic Resection of Curable Colon and Rectal Cancer http://www.sages.org/publications/guidelines/guidelines-for-laparoscopic-resection-of-curable-colon-and-rectal-cancer/. Moreover, extracorporeal anastomosis is mentioned in the ASCRS Global Assessment for Laparoscopic Right Hemicolectomy http://www.apdcrs.org/GlobalAssessmentLapRightHemicolectomy.pdf.

If you are still concerned about the definition, please post your comment also to Dr. Tonia Young Fadok and Dr. Heidi Nelson. I think it would be very interesting to know their opinion.

Best regards