Z skin incision in reduced-port surgery for colorectal cancer

Abstract

Abstract. Laparoscopic surgery for colorectal cancer (CRC) has recently gained in popularity due to the fewer trocars and shorter incision, leading to reduced wound pain and improved cosmetic outcome. In July, 2013, reduced-port surgery (RPS) was introduced and has been performed thereafter in our hospital. An umbilical incision is used for a main port in RPS, through which the specimen is removed and the anastomosis is performed. In order to make the incision shorter, we introduced the Z skin incision in RPS. In this study, we aimed to discuss this method and evaluate the short-term outcome. Among CRC patients undergoing RPS, Z skin incision (n=14) was compared to conventional skin incision (n=15). The clinical and surgical factors were evaluated and there were no significant differences in terms of gender, age, body mass index, tumor site, procedure, operative time, blood loss or complications between the two groups. The median incision length at the umbilicus was significantly shorter in the Z incision group (P=0.004). Particularly in functional end-to-end anastomosis, the median incision length was 2.5 cm in the Z skin incision group and 4.0 cm in the conventional incision group (P=0.018). In conclusion, Z skin incision is a useful technique for achieving an effective length of skin incision in RPS for CRC. IntroductionIn recent years, laparoscopic surgery has been widely performed for colorectal cancer (CRC) in a number of institutions. It has been reported that the efficacy of laparoscopic surgery is due to the reduced blood loss, shorter hospital stay, decreased postoperative pain, earlier postoperative recovery and improved quality of life, with oncological outcomes comparable to those with open surgery (1-3). Conventional multiport laparoscopic surgery for CRC is mainly performed using five trocars, namely one for the laparoscopist, two for the operator and two for the assistant. Recently, efforts have been made to reduce the number of trocars and perform a shorter skin incision, in order to reduce wound pain and provide a better cosmetic outcome; therefore, single-incision laparoscopic surgery (SILS) and reduced-port surgery (RPS) have been applied in colectomies (3-7). In SILS and RPS, an umbilical incision is used for multi-trocar access, to remove the specimen and perform the anastomosis; thus, the length of the umbilical skin incision depends on these procedures. A shorter umbilical skin incision may reduce postoperative pain and provide a better cosmetic outcome. A Z-shaped skin incision has been used in orthopedics and plastic surgery (8). The Z-shaped skin incision is used for the relaxation of scar contractures and it may provide an incision that is longer compared with a straight line (9). We attempted to perform a shorter umbilical incision using this method and we herein report the usefulness of the Z skin incision in RPS for CRC. Patients and methods Patients.A total of 33 patients underwent RPS for CRC at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan) betwee...

Short‐ And medium‐term outcomes of reduced‐port laparoscopic surgery in elderly patients with upper rectal cancer: A retrospective cohort study

“…The likelihood of achieving radical treatment has been the primary consideration in selecting the surgical method for treatment of URC, and other cancers. Previous studies 8‐23 have reported similar pathological and long‐term oncological outcomes for RPLS and MPLS. In our study, we reported comparable medium‐term outcomes between RPLS and MPLS for the treatment of geriatric URC, including the number of lymph node resection, rate of positive margin, rate of tumor recurrence, the 3‐year disease‐free survival rate, and the overall survival rate.…”

“…As such, the rate of postoperative complication is one of the key factors used in assessing the suitability of using RPLS for the treatment of URC among elderly patients. RPLS has a similar incidence rate of postoperative complications, postoperative recovery, and length of postoperative hospital stay as MPLS and traditional laparoscopic approaches 8‐23 . Song et al compared the short‐term safety profile of RPLS and MPLS for colorectal surgery, reporting a decrease in postoperative pain and intraoperative volume of blood loss, as well as a shorter time to the first passage of flatus after surgery in patients who underwent RPLS compared to those who underwent MPLS 13 .…”

“…For radical treatment of colorectal cancer, as a reduced‐port laparoscopic surgery (RPLS), SPLS would present additional specific challenges 8‐23 . First, the duration of surgery is significantly longer than for traditional laparoscopic surgery.…”

“…Second, SPLS may fail to achieve radical treatment of colorectal cancer due to the difficulty in achieving complete dissection of the lymph nodes adjacent to the inferior mesenteric arterial and venous roots, which would increase the risk for postoperative tumor recurrence. Third, difficulty in achieving sufficient tissue tension may make it difficult to clearly observe the abdominal anatomy, which would increase the risk of damage to nerves, blood vessels, and the mesenterium 8‐23 . Our study addresses these limitations by comparing the application of RPLS, which includes SPLS, to MPLS for the treatment of upper rectal cancer (URC) among elderly individuals.…”

Robotic complete mesocolic excision of right‑sided colon cancer with bulky lymph node metastases using the da Vinci® Si™ system: A case report

“…The key points that complicate surgeries of right-sided colon cancer are the variations in vascular supply and the inclusion of the surgical trunk (6), which itself has a complex vascular orientation, in the area of lymph node dissection. We have always been conscious of this densely vascular region and, therefore, place a small laparotomy port above the umbilicus, even during laparoscopic surgery (11). Its advantages include easy access to the vessels through the umbilical incision in emergencies, such as bleeding, and extension of the incision for easy conversion to open surgery.…”