Efficacy of Single Port Laparoscopic Colectomies for Colon Cancer Using 3D Visualization With Cordless Ultrasonic Dissection Device

Toshimasa Yatsuoka, Yusuke Nishizawa, Yoji Nishimura, Katsumi Amikura, Yoshiyuki Kawashima, Hirohiko Sakamoto, Yoichi Tanaka, Kazuhisa Ehara, MD. Saitama Cancer Center

INTRODUCTION: Single port laparoscopic colectomies (SILC) has developed from an effort to minimize tissue injury, reduce morbidity, and preserve cosmesis. While SILC is more difficult than standard laparoscopic surgery, the newest advancements in terms of surgical instrumentation, including three-dimensional computed tomography (3DCT), three-dimensional (3D) laparoscopic visual systems and cordless hand-held ultrasonic cautery cutting devices, have permitted SILC surgery to become even more feasible. Our aim was to review our experience and short-term outcomes with SILC since its introduction at our institution. We demonstrate the efficacy of SILC using 3D visualization with cordless ultrasonic dissection device for colon cancer.

METHODS AND PROCEDURES: We retrospectively reviewed consecutive SILC performed by a single surgeon from Dec 2010 to Sep 2014. The surgeon performed SILC with 3D systems using a cordless hand-held ultrasonic cautery cutting device and standard laparoscopic instrumentation. Preoperative 3D images of the major regional vessels were routinely described. The Demographic data, intraoperative parameters, and postoperative outcomes were analyzed and compared with case-matched standard laparoscopic colectomies (LAC).

RESULTS: Of the planned 22 SILC cases, 17 (88%) were completed with a single incision, whereas 4 required an additional port placement and one case were converted to HALS procedure. The largest incision length was significantly shorter for the SILC group (SILC 4.3 cm vs. LAC 5.5 cm, P=0.0151). Compared to the LAC group operative time was shorter (SILC 224 min vs. LAC 246 min) and estimated blood loss was lesser (SILC 47 ml vs. LAC 75 m), but the differences were not statistically significant. There were no statistically significant differences between two groups with respect to harvest lymph node and length of hospital stay. There were no intraoperative complications in SILC procedures. All patients recovered uneventfully.

CONCLUSIONS: Preoperative 3D-CT, intraoperative 3D laparoscopic visual systems and the cordless ultrasonic dissection device have been advanced to enhance SILC skills. Our preliminary results show that this approach can be adopted in a safe and efficacious manner while using advanced surgical instrumentation.t

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