Fumihiko Fujita, MD, PhD, Takehiro Mishima, MD, PhD, Shinichiro Ito, MD, Tomohiko Adachi, MD, PhD, Akihiko Soyama, MD, PhD, Yasuhiro Torashima, MD, PhD, Amane Kitazato, MD, PhD, Taichiro Kosaka, MD, PhD, Kosho Yamanouchi, MD, PhD, Shigeki Minami, MD, PhD, Kengo Kanetaka, MD, PhD, Mitsuhisa Takatsuki, MD, PhD, Tamotsu Kuroki, MD, PhD, Susumu Eguchi, MD, PhD
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
INTRODUCTION: Conventional laparoscopic assisted colon surgery for cancer requires at least a 5 cm skin incision for the extraction of the specimen and the ensuing anastomosis. However, for selected cases, we performed laparoscopic colon resection with an intracorporeal anastomosis, thus allowing for the use of a small abdominal incision. We herein present our technique for the intracorporeal anastomosis and our preliminary results.
METHODS AND PROCEDURES: We retrospectively collected the data, and analyzed the patients who underwent laparoscopic colectomy from February 2011 to May 2012. The intracorporeal anastomotic method was selectively performed only for early-stage colon cancer. The surgical technique was as follows. Four or five trocars were used, and the surgeon uses a 2 mm in diameter grasper with the left hand. First, the lesion lymph nodes are dissected with a non-touch isolation technique. The mesentery is dissected using an ultrasound cutting devise. The lesion of the colon is transected using a linear stapler with adequate margins on both the oral and anal cut ends. Both sides of the bowel are brought together to lie side by side. A laparoscopic linear cutting stapler is deployed through the bowel opening, to form a side-to-side anastomosis. The enterotomy is closed with full thickness 3-0 vicryl continuous suture, and a seromuscular continuous suture is added. If a wide unclosed mesenteric window remains, it should be closed by suturing. The resected specimen enclosed in a bag can be extracted through one of the trocar sites without laparotomy. We compared the results of the intracorporeal anastomosis with extracorporeal anastomosis, and analyzed the data for statistical significance.
RESULTS: Laparoscopic intracorporeal anastomosis was successfully performed for nine consecutive patients (five male and four female). The average age was 63.4 years, and the locations of the tumors were five in the sigmoid colon, two in the descending colon, one in the ascending colon and one in the cecum. The average length of the operation was 220.3 minutes, and the estimated blood loss was 22 ml. Although one case was complicated by a wound infection, there were no major complications, such as anastomotic leakage. During the same period, there were six cases of laparoscopic colectomy with extracorporeal anastomosis performed by the same surgeon. Intracorporeal anastomosis was not inferior to extracorporeal anastomosis in terms of the length of the operation and estimated blood loss.
CONCLUSIONS: The laparoscopic intracorporeal anastomotic method can thus be performed safely, and has the benefit of inducing minimal abdominal wounding in comparison to extracorporeal anastomosis.
Session: Poster Presentation
Program Number: P055