The impact of new technology on surgery for colorectal cancer

Figure 1 Magnetic imager colonoscope: magnetic generator coils built into the endoscope enable its position and presence of looping in the colon to be identified on the monitor.

Figure 2 Variable stiffness colonoscope: illustrating the stiff (hard) and flexible (soft) modes of the endoscope.

Figure 3 Virtual colonoscopy workstation interface (Marconi). T he operator is able to assess the 3-D data set simultaneously in 3 orthogonal planes. The upper right hand image demonstrates the endoluminal viewpoint and sho ws a 3 cm polypoidal malignancy at the splenic flexure.

Figure 4 Thin cut imaging of a rectal carcinoma perpendicular to the long axis of the tumour displays the tumour breaching the muscularis propria and an enlarged lymph node within the mesorectum. Suggested staging T3N1.

Figure 5 Lateral view demonstrating a metallic stent (Boston Sc ientific, Watertown, MA) being deployed across a rectosigmoid carcinoma with the aid of a guidewire. The patient achieved prompt and effective decompression.

Figure 6 Trans-anal endoscopic microsurgery: 50 mm rectos cope is inserted through the anus. An attached stereoscopic binocular viewing ey epiece allows six-fold magnification of the operative field. Constant flow insu fflation with carbon dioxide keeps the rectum dilated.

Figure 7 Radiofrequency ablation: CT scan demonstrates A 3. 5 cm solitary colorectal metastasis in segment 8 of the right lobe of the liver.

Figure 8 Radiofrequency ablation: the post treatment CT scan shows a 4. 5 cm necrotic RFA lesion at the site of the previous tumour (Figur 7). There is typical marginal enhancement and some perfusional anomalies in the subtended liver.

Figure 9 “Davinci”: Operating robot (Intuitive Surgical Ltd).

Figure 10 Stereoscopic 3-D projection laparoscopic glasses (Optimize International).