Reduced port laparoscopic surgery for colon cancer is safe and feasible in terms of short-term outcomes: comparative study with conventional multiport laparoscopic surgery.

PURPOSE: Laparoscopic surgery was previously accepted as an alternative surgical option in treatment for colorectal cancer. Nowadays, single-port laparoscopic surgery (SPLS) is introduced as a method to maximize advantages of minimally invasive surgery. However, SPLS has several limitations compared to conventional multiport laparoscopic surgery (CMLS). To overcome those limitations of SPLS, reduced port laparoscopic surgery (RPLS) was introduced. This study aimed at evaluating the short-term outcomes of RPLS. METHODS: Patients who underwent CMLS and RPLS of colon cancer between August 2011 and December 2013 were included in this study. Short-term clinical and pathological outcome were compared between the 2 groups. RESULTS: Thirty-two patients underwent RPLS and 217 patients underwent CMLS. Shorter operation time, less blood loss, and faster bowel movement were shown in RPLS group in this study. In terms of postoperative pain, numeric rating scale (NRS) of RPLS was lower than that of CMLS. Significant differences were shown in terms of tumor size, harvested lymph node, perineural invasion, and pathological stage. No significant differences were confirmed in terms of other surgical outcomes. CONCLUSION: In this study, RPLS was technically feasible and safe. Especially in terms of postoperative pain, RPLS was comparable to CMLS. RPLS may be a feasible alternative option in selected patients with colon cancer.

Intra-operative double-stapled colorectal or coloanal anastomotic complications of laparoscopic low anterior resection for rectal cancer: double-stapled anastomotic complication could result in persistent anastomotic leakage.

BACKGROUND: Laparoscopic surgery for rectal cancer is technically demanding and can be hindered by unexpected intra-operative complications. Among the various intra-operative complications, double-stapled anastomotic complications are more serious and complicated to manage. The purpose of this study is to analyze the impact of intra-operative double-stapled colorectal or coloanal anastomotic complications on short-term surgical outcomes and persistent leak, and risk factors of intra-operative double-stapled anastomotic complication. METHODS: Consecutive 363 cases of laparoscopic low anterior resection from August 2004 to November 2012 were analyzed in this study. We retrospectively reviewed intra-operative double-stapled anastomotic complications and compared patient characteristics, surgical data, post-operative clinical data, and pathological data between groups with and without intra-operative double-stapled anastomotic complications. And we analyzed risk factors for double-stapled anastomotic complication. RESULTS: There were 20 intra-operative double-stapled anastomotic complications among the patients (5.5 %). Operation time was longer (304.8 ± 122.0 vs. 197.1 ± 87.5 min, p = 0.001) and more diversion ileostomy were made (75 vs. 34.7 %, p < 0.001) in the group with double-stapled anastomotic complications. There were no differences in terms of surgical morbidity, conversion rate, anastomotic leakage, and hospital stay. However, there was more persistent anastomotic leakage (15 vs. 0.9 %, p = 0.003) in the group with double-stapled anastomotic complications. In univariate analysis, risk factors for double-stapled anastomotic complications were male, T4 stage lesion, and three or more stapler firings. CONCLUSIONS: The double-stapled anastomotic complications during laparoscopic low anterior resection increased operation time and rate of diversion ileostomy. Although these factors did not adversely affect short-term surgical outcome including post-operative morbidity and anastomotic leakage, double-stapled anastomotic complications could increase persistent anastomotic leakage rate.

Initial experience of a surgical fellow in laparoscopic colorectal cancer surgery under training protocol and supervision: comparison of short-term results for 70 early cases (under supervision) and 73 late cases (without supervision).

PURPOSE: Laparoscopic colorectal surgery is a technically challenging procedure for beginners, such as surgical fellows. The purpose of this study was to assess the safety, feasibility, and short-term surgical outcomes of laparoscopic colorectal cancer surgery by a single surgical fellow. METHODS: The study analyzed the data from 143 consecutive patients who underwent laparoscopic colorectal resection by a single surgical fellow between August 2009 and October 2010. The patients were divided into two groups: the early group-the first 70 patients (under supervision of experienced surgeon), and the late group-the last 73 patients (without supervision). The short-term surgical results were compared between two groups. RESULTS: The operations were 24 right colon resections, two transverse colectomies, six left colectomies, 36 anterior resections, 57 low anterior resections, 12 intersphincteric resections, two abdominoperineal resections, three Hartmann's operations, and 1 total colectomy. The mean operating time, mean amounts of blood loss, and conversion rate were similar between the two groups. The morbidity rate, anastomosis leak rate, and mortality rate within 30 days of surgery did not differ significantly. The mean number of lymph nodes was larger in the late group (23.8 vs. 31.7, P = 0.017). In terms of low anterior resection, the mean number of endo-linear staplers used was smaller in the late group (2.46 ± 0.81 vs. 1.97 ± 0.83, P = 0.028). The anastomosis leakage rate in rectal cancer surgery was not significantly different between the two groups. CONCLUSIONS: This study demonstrates that laparoscopic colorectal resections can be independently performed safely after a period of supervision and training by an experienced surgeon.

Transumbilical single-port laparoscopic transabdominal preperitoneal repair of inguinal hernia: initial experience of single institute.

BACKGROUND: Conventional laparoscopic repair of inguinal hernias is generally performed by using 3 ports. In this study, the authors report their initial experiences of transumbilical single-port transabdominal preperitoneal (TAPP) repair of inguinal hernia using a unique "single port." METHODS: Since November 2008, transumbilical single-port TAPP was performed in 24 patients with an inguinal hernia. A wound retractor and a surgical glove attached with 5 mm trocar and 2 pipes were inserted through a 1.5 cm-sized transumbilical incision. TAPP procedure was performed similarly compared with conventional laparoscopy. RESULTS: Transumbilical single-port TAPP repair of an inguinal hernia was successfully performed in 24 patients (19 male and 5 female; 17 with an indirect hernia and 7 with a recurrent hernia; mean age 54.2 y; mean body mass index 24.2 kg/m). No major or minor intraoperative and postoperative complication was encountered and no conversion to conventional 3-port approach or open surgery was required. Mean operating time was 65.6 minutes and mean hospital stay was 2.1 postoperative days. CONCLUSIONS: Transumbilical single-port TAPP repair of an inguinal hernia is technically feasible, provides nearly scarless surgery and can be performed safely and effectively in selected patients with an inguinal hernia.

Simultaneous laparoscopic resection of primary colorectal cancer and metastatic liver tumor: initial experience of single institute.

BACKGROUND: Approximately 20%-25% of patients with colorectal cancer have synchronous liver metastasis at the time of diagnosis. Simultaneous resection of primary colorectal cancer and metastatic liver tumor is the treatment option in colorectal cancer with liver metastasis. The aim of this study was to report our initial experiences of simultaneous laparoscopic resection of colorectal cancer and liver metastasis. METHODS: A single-center, retrospective study of 10 cases of laparoscopic simultaneous resection of colorectal cancer and liver metastasis was carried out. RESULTS: The patients' average age was 63.7 years (range, 48-75 years) and average body mass index was 23.5 kg/m2(range, 20-27.4 kg/m2). The primary cancer was right-sided colon cancer in 4 cases, left-sided colon cancer in 3 cases, and rectal cancer in 3 cases. Single-lesion liver metastasis was found in 6 cases and two or more lesion liver metastasis was found in 4 cases. The mean operating time was 401 minutes (range, 230-620 minutes) and blood loss was 500 mL (range, 60-1000 mL). The mean hospital stay was 10 days (range, 7-15 days). One case was converted to open surgery and anastomotic leakage was encountered in the converted case. CONCLUSIONS: This study shows that simultaneous laparoscopic resection of primary colorectal cancer and liver metastasis is safe and technically feasible in selected patients.