Single-port Laparoscopic Abdomino-perineal Resection (spls-Apr) Through the Colostomy Site

Hyung -jin Kim, MD, Sang-chul Lee, MD, Yoon-suk Lee, MD, Hyeon-min Cho, MD, Jun-gi Kim, MD. Department of Surgery, The Catholic University of Korea

Introduction: Laparoscopic surgery has been proven to be feasible and beneficial for the treatment of colorectal cancer. Single-port laparoscopic surgery (SPLS), which is performed via a small incision, may magnify the advantages of minimally invasive surgery, especially for the cosmetic results. We present our initial experience and a novel technique of single-port laparoscopic abdomino-perineal resection (SPLS-APR) through the colostomy site for low rectal cancer.
Methods: From May 2009 to March 2010, we have performed SPLS-APR through the colostomy site in 6 patients. The mean age was 67.5 years old, the mean BMI was 23.5 kg/m2. A 2.3 cm incision was made at the left lower quadrant abdomen for the colostomy. The single port procedure was conducted with a wound retractor and a surgical glove. We used conventional straight and rigid type laparoscopic instruments, and there was no difference in intracorporeal procedures and range of operation as compare to the laparoscopic APR. Following TME by laparoscopic procedure to the pelvic floor muscles, specimen retrieval was done by a perineal approach. Proximal stump was pulled out and maturated through a preset colostomy site.
Results: The mean incision length was 2.3 cm, and the mean operating time was 238 min. Oral diet was started at 2.3 days after the operation and discharged 6.8 days after the operation. The mean specimen length was 30cm with 21 harvested lymph nodes. There were no perioperative complications. The patients had a virtually scarless abdomen, other than the site of colostomy.
Conclusion: SPLS-APR can be applied for low rectal cancer with the result of a virtually scarless abdomen, except at the site of t colostomy.

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