Reduced-Port Laparoscopic Surgery for Cancer of the Left-Sided Colon

Michiya Kobayashi, MD PhD, Ken Okamoto, MD PhD, Hiromichi Maeda, MD, Ken Dabanaka, MD, Tsutomu Namikawa, MD PhD, Kazuhiro Hanazaki, MD PhD. Department of Human Health and Medical Sciences, Hospital Administration Section, and Department of Surgery, Kochi Medical School

Background: Single incision laparoscopic surgery is now getting performed for cosmetic reasons and is commonly used for cholecystectomy and appendectomy. We perform right colectomies using single incision laparoscopic surgery in patients with benign adenoma and colon cancer. However, it is difficult to perform the surgery of the same quality as the regular multi-port laparoscopic surgery for the left-sided colon cancer. We add a port in the right lower abdomen for lymph node dissection and division of the colon or rectum with linear stapler.
Patients and Method: We performed sigmoidectomy with lymph node dissection for 4 cases. A 3.5 (D2) to 4.5 (D3) cm longitudinal incision was made on the patients’ navels. The subcutaneous tissue was dissected widely. Three 5mm trocars were inserted from the same incision with ample distance between each other.
For case 1, anastomosis was performed extra corporeally. In this case, operation was accomplished with the single incision on the navel. For case 2 with obesity, 3.8mm port was inserted in the left abdomen and 12mm port was inserted in the right lower abdomen. The patient underwent D2 dissection and anastomosis with double stapling technique. Case 3 underwent D2 and anastomosis with double stapling technique. A 12mm port was inserted in the right lower abdomen. After the experiences of these three cases, we performed D3 lymph node dissection with less than 5mm blood loss for a case of lower sigmoid colon cancer (case 4). In this case, we inserted GelPport^? in the 4cm incision on the navel. Three 5mm ports was inserted through GelPport^?, and a 12mm port was inserted in the right lower abdomen, which was used as active port for lymph node dissection and division of the rectum, and also a drain was inserted through the wound.
Results: The operation time was 165, 290, 270 and 150 min. and the blood loss during each operation was 70, 240, 80, and 5ml, respectively. There were no serious complications during or after each operation.
Conclusion: Reduced port laparoscopic colectomy for left-sided colon cancer can be performed safely and should be considered in each institute. The additional port placement in the right lower abdomen ensures the certain and safe lymph node dissection and anastomosis.