Laparoscopic Total Mesorectal Excision for Rectal Cancer by Using a New Device “Lock-Arm” Replacing an Assistant’s Roles

Akihiro Kondo, MD, Masaaki Ito, MD, Yuji Nishizawa, MD, Rie Matsunaga, MD, Takeshi Sasaki, MD, Akihiro Kobayashi, MD. Division of Colorectal Surgery, National Cancer Center Hospital East

INTRODUCTION: An assistant is required to hold surgical forceps and maintain the same position for long time during laparoscopic surgery. These assistant’s roles could be replaced by some surgical devices having the functions as holding or fixing the surgical forceps. We developed a new device as replacer of assistant’s roles, which termed a “Lock-Arm”, developed by collaboration with Japanese company, SYSTEM JP. The purpose of this study is to show how to use this new device in laparoscopic total mesorectal excision (TME) and to assess the tips, surgical merits and safety by using this one.

METHODS AND PROCEDURES: We performed laparoscopic TME by use of this device in 37 patients with low rectal cancer. The Lock-Arm could be used not for holding endoscopy during laparoscopic surgery but for controlling an assistant’s forceps. The Lock-Arm is shaped with multiple joint, and we can easily move these forceps to every direction surgeon want to and fix them at any position by controlling a foot pedal without using surgeons’ hand. Especially in laparoscopic TME, the Lock-Arm could play very important roles controlling the rectal traction through the suprapubic port site. Good surgical exposures during laparoscopic TME could be achieved by fixing and making the proper traction of the rectum with surgical forceps controlled by the Lock-Arm. This also provided stable fixation and rapid movement in a surgical field and did not interrupt the surgeon’s forceps during the procedure.

RESULTS: Of 37 patients with low rectal cancer, 21 were men and 16 were women. The median age was 59 years (range, 35-80 years), median operating time was 260 minutes (range, 133-500 minutes) and median blood loss was 40 mL (range, 5-818 mL). No adverse events relating the use of this device were found in laparoscopic TME.

CONCLUSION: The “Lock-Arm” could be used safely and replace the assistant’s roles such as quick movement and stable fixation of the rectum in laparoscopic TME.

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