Single-incision plus one port laparoscopic anterior resection for rectal cancer: single institutional 56 initial experiences.

Masakazu Hattori, PhD, Yasumitsu Hirano, PhD, Kenji Douden, PhD, Yasuo Hashizume, PhD

Fukui Prefectural Hospital

Introduction: Only limited data in the literature about single-incision laparoscopic rectal surgery, because the laparoscopic stapler does not allow low rectal transection without sufficient distal margins from the umbilicus port. We have developed single-incision plus one port laparoscopic anterior resection of the rectum (SILS+1-AR) as a reduced port surgery in which we can utilize the incision for drainage as an additional access route for laparoscopic procedures including the transection the lower rectum.

Methods: A Lap protector (LP) mini was inserted through a 2.5cm transumbilical incision, and an EZ-access was mounted to LP and three 5-mm ports were placed in EZ-access. A 12 mm port was inserted in right lower quadrant. Almost all the procedures were performed with usual laparoscopic instruments, and the operative procedures were much the same as in usual laparoscopic low anterior resection of the rectum using a flexible 5mm scope. The rectum was transected using endoscopic linear stapler inserted from the right lower quadrant port.

Results: We underwent modified SILS+1-AR in 56 patients with advanced rectal cancer. Two patients were converted to laparotomy and one patient required an additional port insertion. The other 53 patients (93.9%) underwent a curative anterior resection of the rectum. We transected the lower rectum with laparoscopic stapler inserted from the port of the right lower quadrant. Intra- or postoperative complications occurred in three patients (2 anastomotic leakages and one intra-peritoneal abscess).

Conclusions: The safety and feasibility of SILS+1-AR for advanced rectal cancer was established in this study. However, further studies are needed to prove the advantages of this procedure to conventional laparoscopic surgery.

Session: Poster Presentation

Program Number: P057

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