A hydraulically driven colonoscope

BACKGROUND: Conventional colonoscopy requires a high degree of operator skill and is often painful for the patient. We present a preliminary feasibility study of an alternative approach where a self-propelled colonoscope is hydraulically driven through the colon. METHODS: A hydraulic colonoscope which could be controlled manually or automatically was developed and assessed in a test bed modelled on the anatomy of the human colon. A conventional colonoscope was used by an experienced colonoscopist in the same test bed for comparison. Pressures and forces on the colon were measured during the test. RESULTS: The hydraulic colonoscope was able to successfully advance through the test bed in a comparable time to the conventional colonoscope. The hydraulic colonoscope reduces measured loads on artificial mesenteries, but increases intraluminal pressure compared to the colonoscope. Both manual and automatically controlled modes were able to successfully advance the hydraulic colonoscope through the colon. However, the automatic controller mode required lower pressures than manual control, but took longer to reach the caecum. CONCLUSIONS: The hydraulic colonoscope appears to be a viable device for further development as forces and pressures observed during use are comparable to those used in current clinical practice

Coloanal Anastomosis: « How I do it ».

Colo-anal anastomosis represents the only surgical method allowing both resection of the distal third of the rectum and re-establishment of intestinal continuity. Technically similar to a low anterior resection, a transanal approach is used for the distal dissection as this is the only way to ensure that the mucosal excision continues as far as the dentate line. Intestinal continuity is then restored by fashioning a colo-anal anastomosis under direct vision. Alternatively, a colonic reservoir can be created in the form of a J and a pouchanal anastomosis fashioned. A proven technique for this surgical procedure is discussed

Chirurgie colique dans le traitement de la constipation chronique

La chirurgie colique a une place limitée et controversée dans la prise en charge de la constipation chronique. Elle nécessite une sélection rigoureuse et des investigations extensives de l'ensemble de la physiologie gastro-intestinale et du psyché. Le traitement chirurgical a un taux de succès significatif lorsque son indication est posée de manière scrupuleuse. Le patient idéal présente une constipation à temps de transit ralenti, uniquement colique. Une fonction anorectale et un profil psychologique normaux influencent favorablement le pronostic. Cette chirurgie fonctionnelle est grevée de complications significatives telles que diarrhées, incontinence anale ou iléus grêle et d'un taux de récidive Important. L'indication à la chirurgie colique pour constipation chronique ne doit donc être posée qu'avec réserve, fondée sur un tableau clinique et des investigations convaincantes

Prognostic significance of K-ras mutations in colorectal carcinoma.

In Dukes' B and C primary tumours, mutations other than GGT to GAT identify patients at very high risk of recurrence. Our reslults indicate that determining the K-ras mutations provides a good prognostic factor in patients with advanced colorectal carcinoma