Single-Access Laparoscopic Rectal Surgery Is Technically Feasible

Abstract

Introduction. Single-access laparoscopic surgery (SALS) has been successfully introduced for colectomy surgery; however, for mid to low rectum procedures such as total mesorectal excision, it can be technically complicated. In this study, we introduced a single-access technique for rectum cancer operations without the use of other instruments. Aims. To show the short-term results of single-access laparoscopic rectal surgery in terms of pathologic results and immediate complications. Settings and Design. Prospective study. Materials and Methods. We selected middle rectum to anal canal cancer patients to undergo single-access laparoscopic rectal resection for rectal cancer. All patients had total mesorectal excisions. An umbilical incision was made for the insertion of a single multichannel port, and a mesocolic window was created to identify the inferior mesenteric artery and vein. Total mesorectal excision was performed. There were no perioperative complications. The mean operative time was 269 minutes; the median hospital stay was 7 days; the mean wound size was 5.5 cm; the median number of harvested lymph nodes was 15; and all patients had intact mesorectal capsules. Statistical Analysis Used. Mean, minimum–maximum. Conclusion. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained.

Lymph node harvest in single incision laparoscopic surgery for colorectal malignancy

“…It was also slightly higher than the median lymph node harvest presented as a result of a Cochrane review on multiport laparoscopic colorectal surgery [3]. Very recent articles give lymph node counts of 15-21 for colon [28,29] and 13-15 for rectal cancer [30,31]. These data are of the same order as our results, which were a median of 18 lymph nodes in the SILS specimens with an average of 17 for colon and 20 for rectal cancer.…”

Transanal total mesorectal excision assisted by single-port laparoscopic surgery for low rectal cancer

“…So the progress of multiple-port laparoscopic surgery (MPLS) to single-port Although the feasibility of SPLS for colon cancer has been well demonstrated [13], SPLS for rectal cancer, particularly for cancer lying in the distal rectum, is definitely more difficult and challenging [3,14,15]. NOTES in the field of rectal surgery was more of an ideal concept rather than a general practice before the advent of TaTME.…”

Comparison between the perioperative results of single‐access and conventional laparoscopic surgery in rectal cancer

“…showed excellent results , although there were some deficiencies in terms of instrument collision, excessive traction on the rectum for pelvic dissection, and restricted video laparoscopic view. Some later reports presented a modified technique that solved these problems in SALS for rectal cancer surgery with acceptable oncologic results . The one difficult point in SALS is determining how to apply the endo‐stapler; the options are as follows: (i) add one more port for ileostomy creation or drain placement ; (ii) the prolapsing technique ; and (iii) add another port in a multichannel port.…”

“…In the SALS group, the author used either a Glove Port‐Single Port (Nelis Ltd., Bucheon, South Korea) or the glove technique with a SILS Port (Covidien, Dublin, Ireland) . Figure a shows the trocar placement with glove technique, and Figure b shows this with the Glove Port‐Single Port.…”