Needlescopic surgery for low rectal cancer

Jun Nagata, Yosuke Fukunaga, Atsushi Ogura, Shunsuke Hamasaki, Yukiko Takatsu, Toshiya Nagasaki, Takashi Akiyoshi, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Masashi Ueno. The Cancer Institute Hospital of JFCR

Introduction: Laparoscopic colorectal surgery has been shown to result in reduction of postoperative pain and complications. Needlescopic surgery(NS) is minimally invasive technique that does not reduce the number of ports, maintaining the same level of quality as conventional laparoscopic surgery. Needlescopic surgery has performed in our institute since June 2011. In case of abdominoperineal resection (APR) or intersphincteric resection (ISR), the spiecimen is extracted from perineal incision or anus. Therefore, maximum port size is within 5 mm. It is expected that Needlescopic surgery for APR/ISR (NS-APR/ISR) reduces the postoperative pain. The aim of this study is to describe this technique, and to investigate its feasibility for rectal cancer surgery.

Method: From 2011 to 2014, 27 patients underwent NS-APR/ISR in our institution, involving 5 mm and 3 mm ports, with the exception of the skin hole of colostomy. Mainly 5 mm scope is used through umbilical port. The specimen is extracted through the perineal incision or anus.

Results: The mean age was 57(37-89).  The mean operating time was  290(215-585)minutes, and the mean estimated blood loss was 50(3-900)mL. There were 3 postoperative complications (more than Grade III of Clavien-Dindo). There was no conversion to open surgery and no mortality.

Conclusion: NS-APR/ISR for rectal disease is technically and oncologically feasible procedure.

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