A) Description and aims
Laparoscopic colon and rectum surgery is still contradict, especially in treatment of malignant
diseases. Today increasing number of operations in world colon and rectum surgery runs this
way; although frequency of these operations at all 15 % of total number large bowel
operations is not satisfactory.
In Croatia these operations performs back in five years, and number of operations is not
satisfactory.
These operations perform in only few hospitals in Croatia (Split, Rijeka and Zagreb). The
biggest problem is adequate education. That is the reason why in Europe and world courses
like this are organised, and students acquires knowledge and abilities of laparoscopic colon
and rectum surgery.
At the end of course students will acquire following knowledge and abilities:
 Basic knowledge about anatomy and embryology of large bowel – development,
malformations,
blood
supply,
lymphatic
drainage,
innervations
–
clinical
implementation.
 Equipment and instruments which are necessary for these operations. Usage modality
and working principles of high frequency current and harmonic scalpel, different types
of staplers, cost of particular instruments, guidelines for usage particular instruments
and equipment.
 Preparing patients for operation, preoperative bowel preparing, patient fitting in
operation hall, position and accommodation of operative time and equipment.
Preoperative preparation and nutrition, diagnostic tests algorithms, relationship
between preoperative diagnostic tests and decision making. Indications for
laparoscopic operation, patient choice for each operation, operation strategy, access to
operation field, trocar positioning.
 Contraindications for laparoscopic operations. Influence of former operations, general
patient condition, nutrition / obesity at choice of operation procedure, patient and
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trocar position. Choice of patients which are suitable for open operation, experience
effect at operation procedure choice, learning curve.
 Techniques of laparoscopic right hemicolectomy - cancer and Crohn disease.
Differences of the access and radicality. Methods of preparation – medial and lateral
access, mobilisation, blood vessels ligature, resection, anastomosis creating.
 Techniques of laparoscopic sigmoidectomy, left hemicolectomy and rectum
procedures: cancer and diverticulosis. Differences of access and radicality. Methods of
preparation – medial and lateral access, mobilisation, blood vessels ligature, resection,
anastomosis creating.
 Postoperative patient course, parenteral and enteral diet, electrolytes correction,
antibiotics, anticoagulants, importance of early patient mobilisation and early
introduction of enteral diet – importance of ‘’fast track surgery’’.
 Early identification of complications and ways of treatment – conservative or surgery
access.
 Evidence based medicine – published data about results of colon and rectum
laparoscopic surgery, level of significance, principles of evaluation each publication,
instructions for design of particular scientific paper.
 Information and open questions about advantages and imperfections in laparoscopic
colon surgery, comparison of values and imperfections in laparoscopic versus open
colon and rectum surgery.
 Training on live anesthetised pigs. Trocar alignment for each operation,
accommodation of operation team and equipment, equipment connection, adjustment
of desirable settings, equipment problem deflection. Location of surgeon in regard to
target organ.
 Ability acquirement in operations at live anesthetised pigs – bowel resections, access
and mobilisation of large bowel. Provision of blood vessels (harmonic scalpel, high
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frequency bipolar current, stapler), adjustment altitude for bowel resection, resection
abilities, stapler usage, limphadenectomy, bowel resection, anastomosis creating,
technical details, intraoperative complications.
B) Programme – in attachment
C) List of lecturers:

Prof. Zdravko Perko, MD, PhD, Clinical Hospital Split and Medical School –
Course Director

Prof. Ivica Grković, MD, PhD, Split Medical School, Department of Anatomy

Prof. Nikica Družijanić, MD, PhD, Clinical Hospital Split and Medical School
D) Descriptions of documentary materials:
Published relevant articles about laparoscopic colon surgery (especially EAES and
SAGES instructions, multicentric studies, video recorded materials, lectures on CD, book
and CD ‘’Laparoscopic colorectal surgery’’ (participants will acquire book and CD which
included: indications, contraindications for laparoscopic operations, preoperative
arrangement, operation access and techniques, techniques of laparoscopic colon and
rectum surgery, postoperative period, adjuvant therapy.)
E) Exam – written examination
F) Certificates – on the end of the meeting
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