Use of the FJ Clip for application of the marionette technique in reduced-port surgery performed for sigmoid or rectosigmoid cancer

Abstract

Background:We have devised a technique by which we establish the operative field and apply countertraction during performance of reduced-port surgery for sigmoid colon cancer or rectosigmoid colon cancer. The technique was devised to overcome the limitations of reduced-port surgery (RPS) and singleincision laparoscopic surgery (SILS). We applied the technique in 17 patients treated between March 2019 and April 2020.Methods: Three ports were used in all cases, a 12-mm port inserted via the umbilical fossa, a 5-mm port inserted in the right upper abdomen, and a 5-mm port inserted in the right upper lower abdomen. We used a free jaw (FJ) Clip with two pull threads to apply traction from the left upper and left lower abdominal walls (FJ Clip-marionette technique) and to thus supersede the need for assistant forceps. As with the conventional method, the medial to lateral approach was used, the surgery included appropriate lymph node dissection, and a double-stapling anastomosis or functional end-to-end anastomosis was created.Results: Patients began oral intake at a mean of 2.4 days (range, 2-3 days), and mean postoperative hospital stay was 10.3 days (range, 9-15 days). The mean number of lymph nodes retrieved was 17, with lymph node metastasis being identified in 2 patients on histopathologic examination. The mean proximal resection margin was 94.9 mm, and the mean distal resection margin was 58.5 mm. There were no postoperative complications, and there has been only 1 recurrence to date, befalling the patient with stage IV disease.Conclusions: SILS and RPS require surgical field deployment and peeling and dissection by the surgeon alone, but countertraction and the visual field are often insufficient. Use of the FJ Clip-marionette technique allows for countertraction to be maintained and a good view of the operative field. It provides for a procedure close to that of multiport surgery but without the need for an assistant surgeon.