Toshiaki Hagiwara, Yuki Tsuchiya, Shunsuke Motegi, Ryoichi Tsukamoto, Shingo Ito, Shingo Kawano, Shun Ishiyama, Kiichi Sugimoto, Makoto Takahashi, Yutaka Kojima, Tetsu Fukunaga, Yoshiaki Kajiyama, Seiji Kawasaki, Kazuhiro Sakamoto. Juntendo University
Aims: We describe laparoscopic surgery for rectal cancer using needlescopic instruments performed at our department
Methods: From 2012 to 2016, 19 cases of rectal cancer underwent surgery using needlescopic instruments: 3 cases at rectosigmoid colon, 5 at upper rectum, and 11 at lower rectum. An umbilical camera port (12-mm) and two needlescopic instruments (EndoReliefTM) were directly punctured into the assistant surgical site. We started with 5 port sites. In low rectum cancer cases, we kept the good pelvic visualization to lifting the peritoneum of the bladder onto the ventral side using the Lone Star Retractor StaysTM.
Results: The median age was 70 years (56-91 years), with 9 males and 10 females, and body mass index was 21.1 kg/m2 (16-25 kg/m2). Anterior resection was performed in 2 cases, low anterior resection in 7 cases, intersphincteric resection in 4 cases, abdominoperineal resection in 4 cases, Hartmann’s procedure in 2 cases, and lateral lymph node dissection in 1 case. In addition, one case of T4b (bladder) was converted from laparoscopic to open surgery. However, there were no cases in which needlescopic instruments were replaced with conventional forceps. Moreover, intraoperative complications related to the forceps were not observed.
Conclusions: In rectum cancer surgery, needlescopic instruments leave a small postoperative wound; healing is rapid and the cosmetic result is excellent. Surgical safety is comparable to that using conventional forceps. There is no problem with the rigidity of needlescopic instruments. However, where the shaft is curved, operative control requires attention to mobility and directionality. In low rectum surgery, use of needlescopic instruments is limited due to the curvature of the shaft during the dissection of the anterior rectum wall, but it is possible to maintain a good field of view by using auxiliary equipment. Therefore, more cases could be considered for surgeries using needlescopic instruments with the help of auxiliary equipment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88420
Program Number: P291
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster