Clinical Results of Less Invasive Laparoscopic ISR By Using Needle Devices and Surgical Clips

Masaaki Ito, MD PhD, Yusuke Nishizawa, MD PhD, Akihiro Kobayashi, MD PhD, Masanori Sugito, MD PhD, Norio Saito, MD PhD. National Cancer Center Hospital East

Objective: The aim of this study was to create surgical techniques by using needle forceps and surgical clips in laparoscopic intersphincteric resection (New Lap ISR) and to clarify the short-term results of the less invasive laparoscopic procedure for very low rectal cancer near the anus.
Methods: We performed New Lap ISR for 12 patients with very low rectal cancer of stage 1. Instead of 5mm surgical forceps generally used in conventional Lap ISR, we used needle forceps of 2 or 3 mm in length. To reinforce the traction by the needle devices, new clips were developed for special use of New Lap ISR. The clips were inserted through a 10 mm camera-port sited in the umbilicus and attached by nylon sutures which were pulled out through the abdominal wall. We could grasped tissues by them and control the traction of the surgical clips by pulling the sutures through the external wall of the abdomen. We assessed perioperative clinical results of the surgical procedures. Results: Two needle devices and 3 clips were generally used in New Lap ISR. We have not experienced conversion to open and complication during surgery in all patients. Median operative time was 344min and blood loss was 160 ml in this series which showed the statistically better than one in conventional Lap ISR (p<0.05). We had one postoperative reoperation due to the anastomotic leakage. The rates of anastomotic leakage were found in 8%. R0 operation was achieved in all patients. Total length of the wound was 21mm on an average. Fecal incontinence score was 9 points, and the anal function in New Lap ISR was comparable to one in conventional Lap ISR. Of 12 patients, diverting stoma was not created in 9 patients who showed only scars on surgical sites of the abdomen. Conclusion: The short-term results of New Lap ISR were clinically acceptable and comparable to conventional Lap ISR. The new technique by using needles and clips enabled us to accomplish a less invasive laparoscopic ISR and will be considered as one of the new options in reduced port surgery.
 

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