Efficacy of hybrid 2-port hand-assisted laparoscopic surgery (Mukai's operation) for patients with primary colorectal cancer

Abstract

Abstract. In this study, a total of 108 patients with primary colorectal cancer who underwent hybrid 2-port hand-assisted laparoscopic surgery (HALS) were classified as 58 patients with colon cancer and 50 patients with rectal cancer. The mean operating time, mean blood loss, postoperative complications, and mean postoperative hospital stay were compared between the two groups. In patients who underwent colon cancer surgery, the mean operating time was 2 h and 26 min, the mean blood loss was 166.3 ml, and the postoperative complications were wound infection in 5/58 patients (8.6%), postoperative ileus in 3 patients (5.2%), and anastomotic stricture in 1 patient (1.7%). There was no anastomotic leakage and no conversion to conventional open laparotomy. The mean postoperative hospital stay was 12.6 days. In patients who underwent rectal cancer surgery, the mean operating time was 3 h and 38 min, the mean blood loss was 238.8 ml, and the postoperative complications consisted of wound infection in 6/50 patients (12.0%), anastomotic leakage in 3/35 patients (8.6%), anastomotic stricture in 3/47 patients (6.4%), postoperative ileus in 3/50 patients (6.0%), and conversion to conventional open laparotomy in 1/50 patients (2.0%). A covering stoma was constructed during surgery in 12/47 patients (25.5%). The mean postoperative hospital stay was 19.1 days. These results suggest that hybrid 2-port HALS (Mukai's operation) could become a standard method for the treatment of colorectal cancer, and that the long-term outcome should be compared in detail with that of standard laparotomy in the future. IntroductionLess invasive surgery such as laparoscopy-assisted colorectal surgery (LACS) has become popular in recent years, and its indications have expanded markedly from additional resection in patients with stage I colorectal cancer to radical resection in patients with stage II/III cancer and palliative surgery for patients with advanced stage IV disease (1-5). Unlike Western countries, where hand-assisted laparoscopic surgery (HALS) and hybrid HALS combined with open manipulation are performed (6-9), the main type of surgery employed in Japan is pure LACS with 5-6 ports including a camera port for manipulation and a small incision of 35-45 mm (10-12). However, at least 3 surgeons experienced with smooth camera operation are required for pure LACS since the operation is mostly performed by the operator and first assistant manipulating four forceps. Pure LACS has the following disadvantages compared with ordinary open laparotomy: i) poor palpation/tactile sensation, ii) limited applicability with respect to large and heavy tumors, ii) difficulty in assessing the total operating field, iv) a longer operating time as laparoscopic manipulation while observing the monitor is the main procedure, and v) a requirement to acquire specific skills and pass the certification exam in Japan. In addition, LACS cannot become the standard operation even at a relatively large general hospital since it requires several experienced surgeons to s...

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