Mari Shimada, MD1, Yasumitsu Hirano, MD, PhD2, Chikashi Hiranuma, MD, PhD1, Masakazu Hattori, MD, PhD1, Kenji Douden, MD, PhD1, Yasuo Hashizume, MD, PhD1. 1Fukui Prefectural Hospital, 2Teikyo University Mizonokuchi Hospital
Aim: In curatively intended resection of sigmoid and rectal cancer, many surgeons prefer to perform ligation of the root of the inferior mesenteric artery (IMA), high tie, because of oncological reasons. However, ligation of the IMA has been known to decrease blood flow to the anastomosis. There are few reports of patients undergoing the reduced port laparoscopic approach (RPS) including single-incision laparoscopic approach (SILS) even among those undergoing laparoscopic lymph node dissection around the IMA with preservation of the left colic artery (LCA). Our objective was to evaluate the quality of this procedure regarding application of RPS for the treatment of sigmoid and rectal cancer.
Methods: The feasibility of this procedure was evaluated in 61 consecutive cases of RPS for sigmoid and rectal cancer. A Lap protector (LP) was inserted through a 2.5cm transumbilical incision, and an EZ-access was mounted to LP and three 5-mm ports were placed. Almost all procedures were performed with standard laparoscopic instruments using a flexible scope (SILS). A 12 mm port was inserted in right lower quadrant mainly in rectal cancer surgery (SILS+1). Our method involves peeling off the vascular sheath from the IMA and dissection of the LN around the IMA together with the sheath.
Results: Lymph nodes around the IMA were dissected with preservation of the LCA in 26 cases (group A). The IMA was ligated at its root in 35 cases (high tie, group B). In group A, 11 patients were treated with SILS and 15 patients were treated with SILS+1. In group B, 15 patients were treated with SILS and 20 patients were treated with SILS+1. Median operative time was 187.7, and 154.8 min for group A, and B, respectively. The operative time was significantly longer in group A. Estimated blood loss was 13.7 and 13.0 g, and mean numbers of harvested LN were 21.7, and 23.8. None of the other operative results of groups A and B were different statistically. In this series, there was only one anastomotic leakage in group B.
Conclusion: Our method allows equivalent laparoscopic lymph node dissection to the high tie technique. The operative time tends to be longer, however this procedure has a possibility to reduce an anastomotic leakage.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86761
Program Number: P197
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster