Two-port hand-assisted laparoscopic surgery for the 2-stage treatment of a complete bowel obstruction by left colon cancer: A case report

Abstract

A 69-year-old woman presented to her local clinic with vomiting and abdominal distension. Since a bowel obstruction by left colon cancer was suspected due to a marked dilation of the transverse colon, she was referred to our hospital. On admission, an enema disclosed a complete obstruction at the splenic flexure of the colon. An emergency operation was performed, and a temporary loop colostomy was fashioned on the left side of the transverse colon within the range of resection for 2-stage radical surgery. On hospital day 16, a left hemicolectomy D2 was performed by 2-port hand-assisted laparoscopic surgery (2P-HALS) using the stoma as the hand access site, and the tumor was resected along with the removal of the stoma. After surgery, a slight wound infection occurred at the hand access site, but this healed with conservative management. On day 36, she was discharged from hospital. The histological diagnosis was Type 2 circumferential well-differentiated adenocarcinoma with local peritoneal dissemination. Our experience suggests that 2-stage surgery combined with 2P-HALS is applicable even to a large obstructing left colon cancer. This method is less invasive, safe and achieves excellent results, including a good cosmetic outcome.

Hybrid 2-port hand-assisted laparoscopic surgery for the 2-stage treatment of a complete bowel obstruction by distal sigmoid colon cancer: A case report

“…We always reduce the intraluminal pressure first by creating a loop colostomy within the range of subsequent curative resection in patients with complete bowel obstruction by left colon cancer. After the general condition of the patient has improved and adequate work-up has been completed, curative resection of the tumor with removal of the stoma is performed as an elective surgery (5,12). This method involves two-stage surgery, but it has the advantage of only one anastomosis, as well as no effect on curability, and no complications such as anastomotic leakage or stenosis associated with closure of the stoma.…”

“…Since hybrid 2-port HALS is conducted with a small incision and only two ports, this represents a major difference from pure LACS using 5 to 6 ports. The features of hybrid 2-port HALS are as follows: i) palpation and tactile sensation ensure safe and reliable surgery; ii) protective and smooth procedures can be carried out by manual manipulation, particularly in patients with large and heavy tumors; iii) the procedure can be performed by only two surgeons; iv) it is an extension of standard operation, so the operating time is shorter; and v) there is only a shallow learning curve for the procedure (5,13).…”

“…Problems with the comparatively long operating time have also been pointed out (5). To solve these problems, we considered the use of hybrid 2-port HALS, in which HALS is combined with open surgery via a small incision (45-55 mm) as the hand access site (5,12,13). Since hybrid 2-port HALS is conducted with a small incision and only two ports, this represents a major difference from pure LACS using 5 to 6 ports.…”

“…However, such pure LACS is difficult to perform in patients with complete bowel obstruction by left colon cancer or those who require combined resection due to invasion of other organs such as the urinary bladder or other parts of the intestine. Problems with the comparatively long operating time have also been pointed out (5). To solve these problems, we considered the use of hybrid 2-port HALS, in which HALS is combined with open surgery via a small incision (45-55 mm) as the hand access site (5,12,13).…”

“…The indications for LACS cover a very wide range, from additional procedures after endoscopic mucosal resection (EMR) of stage I early colorectal cancer to curative resection of stage II/III cancer and palliative surgery for advanced stage IV cancer (1)(2)(3)(4)(5). Unlike in the West, LACS in Japan does not usually involve hand-assisted laparoscopic surgery (HALS) or hybrid HALS combined with a standard procedure under direct vision (6)(7)(8)(9).…”