Incisionless Laparoscopic Surgery for Colorectal Cancer ~hybrid NOTES Technique Applied to Traditional Laparoscopic Colorectal Resection~

Traditional laparoscopic surgery for colorectal cancer is commonly defined as the form of laparoscopy-assisted surgery with a mini-laparotomy for specimen retrieval. This mini-laparotomy is often the cause of postoperative pain, wound infection, and other pain-related complications. We have developed a new technique of laparoscopic surgery for colorectal cancer. This procedure, called “Incisionless Lap”, is a complete laparoscopic double stapling technique (DST) without mini-laparotomy.
This new technique was employed in patients with relatively early-stage cancer of the sigmoid colon or rectum. Patients requiring transanal anastomosis (e.g., ISR) were excluded.
The procedure uses 4 or 5 ports. Lymph node dissection and mobilization of the bowel are carried out completely via laparoscope. The specimen is extracted through the original anus. Anastomosis is laparoscopically performed with DST. We have used two methods.
Method A: The proximal and distal parts of the lesion are transected with Endo-GIA. The staple at the upper rectum is released, and the lesion is removed through the anus. The Anvil is attached to the proximal part of the bowel laparoscopically, followed by intracorporeal side-to-end anastomosis with DST.
Method B: The proximal part of the lesion is transected with Endo-GIA. Then, the lesion and bowel are pulled out through the anus by means of reversion, followed by transection of the distal side of the bowel with a stapler. The distal side of the bowel is pushed back into the body, and the Anvil is attached to the proximal part of the bowel laparoscopically. This is followed by intracorporeal anastomosis with DST.

Method A was employed in 5 patients; method B in 5. None of the patients developed postoperative complications. Although the postoperative follow-up period to date is still short, no tumor recurrence from the stump has been observed in any patient.

Our experience indicates this “Incisionless Lap” technique is feasible in selected patients with left-sided colonic tumors. Complications related to mini-laparotomy can be entirely avoided with this hybrid approach

Session: Poster

Program Number: P091

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