Browsing by Author "Santorelli, C."

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Single Incision Laparoscopic Surgery (SILS) as surgical option in Crohn's disease: our experience
(Oxford University Press, 2018) Leo, C.A.; Samaranayake, S.F.; Hodgkinson, J.D.; Santorelli, C.; Chandrasinghe, P.C.; Warusavitarne, J.
BACKGROUND:Transanal TME (TaTME) is a new addition to the approaches in rectal surgery. TaTME requires advanced technical skills and, more importantly, knowledge of the pelvic structures, planes, and spaces as they are encountered moving cephalad from the perineum. We have developed a technique for producing 3D reconstructions of the anorectum and associated anatomy, to aid peri-operative planning and understanding of the anatomy crucial to TaTME surgery. METHODS: A patient was scheduled for single incision laparoscopy surgery (SILS) TaTME completion proctectomy and ileoanal pouch formation for ulcerative colitis. Standard axial T2-weighted Spectral Attenuated Inversion Recovery (SPAIR) and sagittal T2-weighted MRI sequences were obtained and digital imaging and communications in medicine (DICOM) images were imported into a validated open-source segmentation software.1 A specialist consultant gastrointestinal radiologist manually segmented the following structures: sphincter complex; rectosigmoid colon; levator plate, bladder, ureters, urethra and prostate. Each mesh was imported into another open-source system, MeshLab V1.3.3.1 as Stereolithography (STL) files for mesh smoothing to be applied. Individual labels were applied to each anatomical structure. RESULTS: Segmentation took approximately 15 min and an additional 10 min was required for smoothing and applying colour and transparency of the anatomical structures to emphasise surgically relevant anatomy. In Figure (A) provides an overview of the anatomy showing a relatively straight and posterior direction of the rectum as it descends into the pelvis; (B) provides insight into the relation between internal sphincter/rectum and the prostate/urethra. Distance between structures and relative proximity can be easily understood. Figure (C) shows the clearance between low rectum and both ureters, whilst (D) shows an anterior oblique view of the sphincter complex and the urethra. Conclusions :Surgeons currently use a combination of MRI scans, reports and discussion with radiologists to better understand anatomy. The use of these reconstructions in the MDT, in clinic and in the operating theatre could be useful to better communicate complex rectal anatomy, identify areas of difficulty and aid surgical planning. Our reconstructions present a present a cost-neutral solution to better visualise the anatomy they represent the first step towards innovation in TaTME surgery.
Single Incision Laparoscopic Surgery (SILS) as surgical option in Crohn's disease: our experience
(Wiely-Blackwell, 2016) Leo, C.A.; Samaranayake, S.F.; Hodgkinson, J.D.; Santorelli, C.; Chandrasinghe, P.C.; Warusavitarne, J.
AIM :Single Incision Laparoscopic Surgery (SILS) is a newer technique which is increasing in popularity. The benefit of SILS in complex Crohn's disease (CCD), which includes a significant cohort of young patients sometimes needing multiple operations has not been comprehensively assessed. This study analyses our early experience with this technique. METHOD: Patients who underwent SILS for CCD were included. Data were collected prospectively from Januray 2013 to December 2015. Ileocolic resections, right hemicolectomy, small bowel stricturoplasties and resections were included in the CCD cohort. Primary and re-do surgeries were analysed separately. RESULTS: A total of 45 patients were included: 39 ileocolic resections, 6 small bowel stricturoplasty/resections. Of the total, 27 were primary resections and 18 were re-do resections. In overall, the median age was 41 years (Range – 14 years–72 years), the median hospital stay was 8 days (Range - 3 days–28 days). Three patients from primary (11%) and 2 from re-do group (11%) had to be converted to open surgery. Total complication rate was 35.5% including 31.1% Clavien Dindo 1 and 2. In term of operating time, average blood loss, conversion rates, complication rate and hospital stay, there was no significant difference between the groups. Six months follow-up showed no major complications. CONCLUSION:We have demonstrated the feasibility of SILS in patients with CCD undergoing both primary and re-do surgeries. There were no significant differences between the two groups. More robust data and longer follow-up is needed in future studies to evaluate this further.
Single incision laparoscopic surgery (SILS) as surgical option in Crohn’s disease: our experience
(Wiely-Blackwell, 2016) Leo, A.; Samaranayake, S.F.; Hodgkinson, J.D.; Santorelli, C.; Chandrasinghe, P.C.; Warusavitarne, J.H.
AIM: Single Incision Laparoscopic Surgery (SILS) is a newer mini-invasive. Benefits of SILS in complex Crohn’s disease (CCD), which includes a significant cohort of young patients sometimes needing multiple operations has not been comprehensively assessed. This study analyses our early experience. METHOD: Data were collected prospectively from January 2013 to December 2015. Ileocolic resections, right hemicolectomy, small bowel stricturoplasties and resections SILS were included in the CCD cohort. Primary and re-do surgeries were analysed separately. RESULTS: A total of 45 patients were included: 39 ileocolic resections, 6 small bowel stricturoplasty/resections. Median hospital stay was 8 days (Range - 3 days – 28 days). Three patients from primary (11%) and 2 from re-do group (11%) had to be converted to open surgery. Total complication rate was 35.5% including 31.1% ClavienDindo 1 and 2. In term of operating time, average blood loss, conversion rates, complication rate and hospital stay, there was no significant difference between the groups. Six months follow-up showed no major complications. CONCLUSION: We have demonstrated the feasibility of SILS in patients with CCD. There were no significant differences between primary and re-do surgeries. More robust data and longer follow-up is needed in future studies to evaluate this further.
Single incision laparoscopic surgery (SILS) for primary surgery in medically refectory ulcerative colitis: a case series
(Wiely-Blackwell, 2016) Chandrasinghe, P.C.; Leo, C.A.; Samaranayake, S.F.; Santorelli, C.; Strouhal, R.; Warusavitarne, J.
AIM:Medically refractive ulcerative colitis (UC) requires surgical intervention. Primary surgery includes subtotal colectomy (STC), restorative proctocolectomy (RPC) or panproctocolectomy (PPC) with end ileostomy. Single incision surgery is gaining popularity in this group of patients. METHOD: Patients who underwent single incision surgery for medically refractory UC from 2013 January to 2015 December were prospectively followed up. Demographics, hospital stay and early complications were analysed. RESULTS: A total of 34 patients were included. There were 21 STCs, 9 PPCs and 4 RPCs done as primary surgery for medically refractory UC. The median hospital stay was 7 days (range: 4–41 days). Four out of 34 patients had a complication with Clavien-Dindo score above 3; (2-re-operation for obstruction (5%), 2 required intensive care for sepsis (5%). Two procedures (5.8%) had to be converted strategically to open. Three patients had cancer in the resected specimen. The median age of those who had PPC was significantly higher compared to those who had restorative procedures (48 years: range 17–69 vs 38 years: range 34–64; P < 0.005). CONCLUSION: Single incision surgery for medically refractory UC is safe with an acceptable complication profile. The quality of life implications of this procedure require further evaluation.