Single incision plus one port laparoscopic anterior resection for rectal cancer

Yasuhiro Ishiyama, Yasumitu Hirano, Kenji Douden, Masakazu Hattori, Yasuo Hashidume. Fukui Prefectural Hospital

Background: 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. In this retrospective study, the perioperative and oncologic outcomes of SILS+1-AR were reported and showed surgical procedure.

Methods: A Lap protector (LP) mini was inserted through a 2.5 cm transumbilical incision, and an EZ-access was mounted to LP and two 5-mm ports and one 12-mm port 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 normally using only one endoscopic linear stapler inserted from the right lower quadrant port.

Results: 124 consecutive patients underwent a single incision plus one port anterior resection for rectal cancer between August 2010 and March 2015. Mean operating time was 180 (range, 81-350) min, with an estimated blood loss of 20 ml. No intraoperative complications or conversions to conventional laparoscopic surgery. Four cases converted open surgery. Four patients required conversion due to the great size of the tumor. 1 case necessitated additional ports. The median times to first postoperative liquid and solid intake were 2 and 3 days, respectively. Most patients were discharged on postoperative day 10. Postoperative complication occurred in the 124 of the 7 cases (5.9%) Complications included five anastomotic leakages (4.0%), one intra-peritoneal abscess (0.8%), one small bowel obstruction (0.8%). The median follow up time was 30 months. Six patients developed recurrence. One patient had died of local recurrence.

Conclusions: In our experience, a single incision plus one port laparoscopic anterior resection for rectal cancer has been shown to be safe and feasible, with operative and oncological outcomes comparable to conventional laparoscopic surgery.