Reduced port surgery for small bowel diseases

Kenji Baba, PhD, Shinichiro Mori, PhD, Yoshiaki Kita, PhD, Masayuki Yanagi, Kan Tanabe, MD, Takaaki Arigami, PhD, Yuto Uchikado, PhD, Yoshikazu Uenosono, PhD, Tetsuhiro Nakajyo, PhD, Kosei Maemura, PhD, Shoji Natsugoe, Prof. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University

OBJECTIVE: Reduced port surgery (RPS) has become an evolving trend over the past few years. We defined RPS for the patients with small bowel disease as the cases of single port surgery (SPS) or one additional port to SPS. In this study, we aimed to describe a novel technique and our experience with 10 patients who underwent RPS for small bowel disease.

METHODS: This study was designed as a retrospective case series. Between September 2009 and August 2015, ten consecutive patients who underwent RPS were included (4 male and 6 female, age: 45.7±24.1 years old). The outcomes were evaluated in terms of operation time, intraoperative blood loss, length of hospital stay after surgery and perioperative complications.

OPERATION PROCEDUERE: We performed double-balloon enteroscopy to mark the lesion with ink, preoperatively. All patients underwent general anesthesia and were placed in the supine position. The skin was cut along a Z-line marked in the umbilical region. We used an EZ-access with a Lap-Protector (Hakko Medical Inc., Chikuma, Japan) for the umbilical access device and an Endo Relief (Hope Denshi Co., Kamagaya, Japan), which has a 2.4-mm shaft with a 5-mm-diameter head for additional port. Three 5-mm trocars were placed through the EZ-access for a 5-mm laparoscope and 5-mm instruments. After setting the EZ-access with the Lap-Protector, pneumoperitoneum was maintained at 10 mmHg using CO2, and a 3-mm trocar was positioned when needed. An exploration of small bowel was performed under the laparoscopy, the lesion, which had been previously marked was immediately identified. The specimen was extracted through the incision with wound protection, after which extracorporeal functional end-to-end anastomosis was performed using linear staplers. At the end of the procedure, the fascia and the skin at the umbilical incision was closed using absorbable sutures.

RESULTS: Six patients who had Meckel’s diverticulum, one patient who had intussusception due to lipoma, one patient who had polyp with Peutz-Jeghers syndrome, one patient who had small intestinal stenosis due to Crohn’s  disease and one patient who had small intestinal hemorrhage were performed RPS, including three patients who added one trocar. Mean of operative time was 110 minutes, and mean of intraoperative blood loss was 10mL. Length of postoperative hospitalization was 7 days. There were no complications and mortality in relation to the operation.

CONCLUSION: Our experience indicates that reduced port surgery for the patients with small bowel disease is a safe and feasible procedure.

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