Single-incision Laparoscopic Right Colectomy With D3 Dissection Focused Upon Counter Traction for Right Sided Colon Cancer

Masanori Kotake, MD, Noriyuki Inaki, MD, Hiroyuki Bando, MD, Tetsuji Yamada, MD. Ishikawa Prefectural Central Hospital

[Introduction]
Recently, laparoscopic surgery has been considered the best treatment for colon cancer. With the advent of Natural Orifice Transluminal Endoscopic Surgery (NOTES), presently there is a strong development in laparoscopic surgery to avoid or reduce the number of the abdominal incisions. Single-incision laparoscopic surgery (SILS) has advantages over NOTES in ease of instrument use and operative technique. Thus, single-incision laparoscopic colectomy (SILC) is rapidly spreading in the field of minimally invasive colon and rectal surgery. But most SILC can’t form effective counter traction. This report presents the surgical technique, safety and feasibility of performing single-incision laparoscopic right colectomy using the E·Z access (Hakko, Japan) and the curved reusable instruments (Richard·WOLF, Germany) for right sided colon cancer. This procedure can form effective counter traction and instrument collision is less than another method.
[Materials and methods]
Between December 2010 and August 2011, SILC was performed for 16 patients . The indication of SILC is only cases the ileocolic vessels (occasionally right colic vessel) are cut. All patients had a cancer of the cecum or ascending colon. Single access to the abdomen was achieved with a 2.5- 3.0cm umbilical incision. The Lap protector was attached to the small incision. After the insertion of a 12-mm trocar into the E·Z access, it was attached at the Lap protector. Second and third 5-mm trocars were inserted. 1st assistant retracted the tissue by the curved reusable instruments without trocar, enabling counter traction in cooperation with operator. The roots of the vascular pedicles were isolated and divided from the superior mesenteric artery and vein during D3 lymph node dissection. The mesocolon was dissected using a medial to lateral approach. In all cases, terminal ileum is transected once using the linear stapler in early phase of the operation, which secure a good view of the operative field, clear anatomy, less damage of the organ and smaller scar of the abdomen. After right coloparietal dissection and hepatic flexure mobilization were performed, the specimen was retrieved through the umbilical port. Extracorporeal anastomosis was performed using the linear staplers. Preliminary short-term results were analyzed retrospectively.
[Results]
There were 7 men and 9 women with a median age of 67 years. Their median body mass index was 22.6 kg/m2. The SILC procedure was performed with a mean incision length of 2.9 cm and a mean operative time of 161 min. Surgical blood loss was 14ml. The mean number of lymph nodes extracted was 18. There were no intraoperative complications , no need to add a second port , and no need to convert to open surgery. The mean postoperative stay was 11.3 days. There were no different from conventional LAC.
[Conclusion]
Our preliminary results show that This procedure are safe and feasible method; nevertheless, larger randomized experiences are needed to demonstrate the benefits of SILC compared with standard laparoscopic resections. We believe that SILC for colon cancer is an effective minimally invasive procedure and a bridge to NOTES for colon resection.