Curative resection by hybrid 2-port HALS in a patient with advanced cecal cancer invading the urinary bladder: a case report.

A 67-year-old woman was referred to our department for assessment of a tumor in the right lower abdomen. Advanced cecal cancer invading the urinary bladder was diagnosed, and laparoscopy assisted colorectal surgery (LACS)-hybrid 2-port hand-assisted laparoscopic surgery (HALS) was performed in February 2008. Intraoperative laparoscopic observation revealed direct invasion of the urinary bladder by the primary tumor, so an approximately 6-cm transverse suprapubic incision was made. Under direct vision through this incision, full-thickness partial cystectomy was performed to remove the tumor invading the bladder. Then D3 right hemicolectomy was performed under pneumoperitoneum. In this patient with advanced cecal cancer invading the bladder, we performed radical curative surgery by hybrid 2-port HALS, a minimally invasive procedure in which a 6-cm incision was made in addition to the hand access site and favorable results were obtained.

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.

In July 2008, a 40-year-old man presented to his local physician with diffuse abdominal pain and severe abdominal distension. Impending bowel rupture due to colonic obstruction was strongly suspected. Complete obstruction of the distal sigmoid colon by a tumor was diagnosed, and emergency surgery was performed. A sigmoid colon loop colostomy was created within the range of subsequent resection to relieve the obstruction. After his general condition had improved and the risks were assessed, curative resection including removal of the stoma was performed by hybrid 2-port hand-assisted laparoscopic surgery. The tumor showed invasion of the serosa without lymph node metastasis, and its pathological diagnosis was stage II. Postoperatively, mild wound infection occurred at the hand access site (stoma), but it resolved with conservative treatment, and the patient was discharged on postoperative day 13. This case is reported here because of the good results.

Trans-anal reinforcing sutures after double stapling for lower rectal cancer: report of two cases.

To safely avoid the construction of a covering stoma in patients with advanced lower rectal cancer undergoing laparoscopy assisted colorectal surgery (LACS), we added circumferential manual reinforcing sutures via the transanal approach at the site of mechanical anastomosis. In June 2008, LACS was performed for a tumor of 6 cm in longer diameter in the Rb region of the lower rectum approximately 5 cm from the anal verge. After intraperitoneal coloproctal anastomosis was performed in the pelvis by the double stapling technique (DST), reinforcement was provided by manual trans-anal suturing (trans-anal reinforcing sutures: TARS). A covering stoma was constructed because this was a high-risk case. Complications such as mild wound infection and stoma trouble occurred, and the patient was discharged after conservative therapy. In June 2008, LACS was performed for a tumor of 5 cm in longer diameter in the Ra region of the lower rectum approximately 7 cm from the anal verge. After intraperitoneal colorectal anastomosis was performed in the pelvis by DST, TARS were added to avoid a covering stoma. Minor leakage occurred postoperatively, but this was controlled conservatively and the patient was discharged. In patients having surgical treatment of advanced lower rectal cancer, good results were obtained by adding circumferential reinforcing sutures via the trans-anal approach at the site of ultra-low anastomosis after DST.