Reduced Port Surgery for Colorectal Cancer

Jun-ichi Tanaka, MD FACS, Tomokatsu Omoto, MD, Shunpei Mukai, MD, Kenta Nakahara, MD, Chiyo Maeda, MD, Yusuke Takehara, MD, Daisuke Takayanagi, MD, Eiji Hidaka, MD, Shungo Endo, MD, Fumio Ishida, MD, Sin-ei Kudo, MD. Digestive Disease Center Showa University Northern Yokohama Hospital


INTRODUCTION – Needlescopic surgery (NSS) and single port surgery (SPS) have been applied in various diseases from the viewpoint of cosmetic outcomes as well as minimal invasiveness, so we have applied these procedures to colorectal cancer (CRC) as reduced port surgery (RPS). We report our initial experience of RPS for CRC to elucidate the technical feasibility of these procedures.
PROCEDURES – The size of skin incision on the umbilicus was ranging 2.5 to 3.5cm, and a single multi-channel port (SILSTM port), a single access platform (EZTM port) or three 5mm trocars directly inserted through the single skin incision were used in SPS. A puncture or a port with 1.8~3.0 mm was used in NSS. Sixty patients with CRC (up to T2 N1 M0) were proposed and underwent RPS including 25 cases of right colectomy, 23 of sigmoidectomy and 12 of rectal resection instead of conventional laparoscope-assisted colorectal resection (LAC). Procedures were medial approach as well as conventional LAC, by parallel method with straight instruments or combined method with articulated instruments and energy devices such as ultrasonic coagulation shears or tissue sealing system. Endoscopic linear stapler or circular stapler also could be used for resection and reconstruction of bowels. Wound protectors such as Wound RetractorTM or Lap ProtectorTM were used in order to prevent port site recurrence during extraction of bowel specimen.
RESULTS – PRS in all patients were carried out successfully except for one case of conversion to conventional LAC due to serious intra-abdominal adhesion. Operating time was longer in RPS procedure for 30 to 40 minutes compared to conventional LAC, however postoperative hospital stay of patients with RPS was not longer than that of patients with conventional LAC. Most patients were satisfied to better cosmetic outcomes.
CONCLUSION – RPS including NSS and SPS for selected colorectal cancer was feasible with better cosmetic results.

Session Number: Poster – Poster Presentations
Program Number: P099
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