Goutaro Katsuno, MD, PhD, Masaki Fukunaga, MD, PhD, Yoshifumi Lee, MD, PhD, Kunihiko Nagakari, MD, PhD, Masahiko Sugano, MD, PhD, Msaru Suda, MD, PhD, Yoshito Iida, MD, PhD, Shuichi Sakamoto, MD, PhD, Seiichirou Yoshikawa, MD, PhD, Yoshitomo Ito, MD, PhD, Masakazu Ouchi, MD, PhD, Emi Tokuda, MD, PhD, Yoshinori Hirasaki, MD, PhD
Department of Surgery, Juntendo Urayasu Hospital, Juntendo University,
Background: Single-incision laparoscopic colorectal resection (SILC) is a recent development of minimally invasive surgery. We report here the strategy and short-term outcomes of the consecutive 150 patients who were treated with SILC for colorectal cancer in these 3 years.
Indications for SILC: The indications for SILC were as follows: (1) tumors located at the cecum, ascending colon, right side of transverse colon, sigmoid colon, or upper rectum; (2) tumor size (less than 7cm); (3) cSE(-); (4) cN0 or cN1; (5) cP(-); and (6) thick bulky mesorectum/mesocolon(-).
Study Design/Method: We reviewed the clinical records of 150 patients who underwent SILC for colorectal cancer between April 2009 and September 2012 at the Department of Surgery of Juntendo University Urayasu Hospital
Procedures: A vertical incision (approximate mean length 2.5 cm) was made. After inserting an atraumatic wound retractor (AlexisTM), which remained in place throughout the procedure, the multi-access port (SILSTM port or EZ accessTM) was manually inserted into the incision. In most cases, standard straight laparoscopic instrument were used. All SILC procedures were performed using similar surgical technique to our standard laparoscopic procedures. Left-sided anastomoses were performed intracorporeally with a circular stapler; right-sided anastomoses were performed extracorporeally. In left-sided colon cancer cases, we usually divide the colon or rectum using the articulating instrument inserted directly through the multi-access port without using an additional port. However, when it is technically difficult to divide the rectum at the lower level, we often use the additional port or NOSE(Natural Orifice Specimen Extraction) technique with prolapsing method to divide the rectum more confidently. We have ever experienced 70 NOSE cases including conventional laparoscocpic colo-rectal resections. In these cases, there was no anastmotic leakage.
Results: 150 SILC procedures were performed. Of them, NOSE with prolapsing method was used in 10 rectal cancer patients, and the additional port technique in 14 patients. The mean operating time was 146 ± 39 min. The mean bleeding volume was 27.1± 16 ml. There was no intraoperative complication. The mean hospital stay was 9.6 ± 1.6 days. Postoperatively, there was no mortality and no major postoperative complications such as anastmotic leakage. One patient (0.7%) was converted to the conventional laparoscpic procedure after single incision approach due to severe adhesion. The number of harvested lymph node was 18±2.1. The mean tumor-free resection margin was 11 ± 4.8 (range, 6–16) cm. Although the postoperative follow-up period to date is still short (median observation period: 21 months), no tumor recurrence or metastasis has been found in any of the cases.
Conclusion: Single-incision laparoscopic colo-rectal resection for selected patients is safe, feasible, and oncologically sound in our experiences. In the difficult cases when pure SILC can not be carried out, additional port technique or NOSE technique could be useful.
Session: Poster Presentation
Program Number: P482