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Introduction The impact of obesity on short‐term outcomes after laparoscopic colorectal surgery (LAC) in Asian patients is unclear. The purpose of the present multicenter study was to evaluate the safety and feasibility of LAC in obese Japanese patients. Methods We retrospectively reviewed 1705 patients who underwent LAC between April 2016 and February 2019. Patients were classified according to body mass index (BMI): non‐obese (BMI < 25 kg/m2, n = 1335), obese I (BMI 25‐29.9 kg/m2, n = 313), and obese II (BMI ≥30 kg/m2, n = 57). Clinical characteristics and surgical outcomes were compared among the three groups. Results The proportion of patients with comorbidities (non‐obese, 58.1%; obese I, 69.6%; obese II, 75.4%; P < .001) and median operation time (non‐obese, 224 minutes; obese I, 235 minutes; obese II, 258 minutes; P = .004) increased significantly as BMI increased. The conversion rate was similar among the groups (P = .715). Infectious complications were significantly high in obese II patients (non‐obese, 10.4%; obese I, 8.3%; obese II, 28.1%; P < .001). Multivariate analysis revealed that in obese II patients, BMI was an independent predictive factor of infectious postoperative complications (odds ratio 2.648; 95% confidence interval, 1.421‐4.934; P = .002). Conclusion: LAC has an increased risk of postoperative infectious complications in obese II patients, despite improvements in surgical technique. Management of obese II colorectal cancer patients requires meticulous perioperative management.

Background Hemostasis is very important for a safe surgery, particularly in endoscopic surgery. Accordingly, in the last decade, vessel-sealing systems became popular as hemostatic devices. However, their use is limited due to thermal damage to organs, such as intestines and nerves. We developed a new method for safe coagulation using a vessel-sealing system, termed flat coagulation (FC). This study aimed to evaluate the efficacy of this new FC method compared to conventional coagulation methods. Methods We evaluated the thermal damage caused by various energy devices, such as the vessel-sealing system (FC method using LigaSure™), ultrasonic scissors (Sonicision™), and monopolar electrosurgery (cut/coagulation/spray/soft coagulation (SC) mode), on porcine organs, including the small intestine and liver. Furthermore, we compared the hemostasis time between the FC method and conventional methods in the superficial bleeding model using porcine mesentery. Results FC caused less thermal damage than monopolar electrosurgery’s SC mode in the porcine liver and small intestine (liver: mean depth of thermal damage, 1.91 ± 0.35 vs 3.37 ± 0.28 mm; p = 0.0015). In the superficial bleeding model, the hemostasis time of FC was significantly shorter than that of electrosurgery’s SC mode (mean, 19.54 ± 22.51 s vs 44.99 ± 21.18 s; p = 0.0046). Conclusion This study showed that the FC method caused less thermal damage to porcine small intestine and liver than conventional methods. This FC method could provide easier and faster coagulation of superficial bleeds compared to that achieved by electrosurgery’s SC mode. Therefore, this study motivates for the use of this new method to achieve hemostasis with various types of bleeds involving internal organs during endoscopic surgeries.

Introduction Single‐incision laparoscopic surgery (SILS) for colon cancer is a recent innovation in minimally invasive surgery that can improve short‐term outcome. However, several biases exist in current favorable comparisons of SILS with conventional laparoscopic (CL) surgery. Moreover, the oncological outcomes in SILS remain unclear. The aim of this study was to identify outcomes following SILS and CL for right colectomy using a propensity score‐matched analysis. Methods A total of 553 patients underwent curative resection for right colon cancer (58 SILS and 495 CL). After propensity score matching, 58 patients in each group were matched. Results Before matching, median age was younger (p = 0.037) and clinical stage was lower (p < 0.001) in the SILS group. After matching, operation time was shorter (172 versus 193 min, p = 0.007) and blood loss was less (12 versus 20 mL, p = 0.037) in the SILS group. Most of the SILS cases were performed (43.1%) or supervised (51.7%) by an expert surgeon. Median follow‐up duration was 30 and 37 mo in the SILS and CL groups, respectively. Three‐year relapse‐free survival was 92.5% and 92.4% (p = 0.781); and overall survival was 100% versus 98.1% (p = 0.177). Conclusions Under the control of expert surgeons, SILS appeared to be a safe and feasible approach and had similar oncological outcomes compared with CL in a propensity score‐matched cohort of patients with right‐sided colon cancer.

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