Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Summary

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.

Abstract

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice.

The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

Introduction

Natural orifice specimen extraction surgery (NOSES) is a modified approach to open surgery and conventional laparoscopic surgery, which relies on laparoscopic or robotic techniques. Its major advantages include a shorter length of hospital stay, reduction in wound complications and postoperative pain, faster recovery of bowel function, and better cosmetic and psychological effects. During NOSES, the surgical specimen is removed from a natural orifice (rectum or vagina) without requiring an auxiliary incision in the abdominal wall¹. The "Expert Consensus on NOSES for Colorectal Tumors (2019 Edition)" recommends NOSES with the five-port t....

Protocol

All laparoscopic surgical procedures and postoperative treatments in this study were performed in accordance with the guidelines established by the Laparoscopic Operation Ethics Committee of the First Affiliated Hospital of Sun Yat-Sen University, China. The research protocol and content were explained to all patients, and informed consent was obtained. This study was conducted under the guidance of the ethics committee of the hospital.

1. Case inclusion criteria

1. Include patients who have been diagnosed with sigmoid colon or high rectal adenocarcinoma (10-15 cm from the anus), who have undergone single-surgeon, ....

Results

No patient had any distal ileal prophylactic stoma. Specimens from six cases were taken from the rectum, and four case specimens from the vagina. The average operation time was 169.5 ± 35.6 min, the average bleeding volume was 40 ± 13.3 mL, the average postoperative exhaust time was 43.2 ± 22.1 h, the average number of lymph nodes dissected was 13.1 ± 8.6, and the average hospital stay was 13.2 ± 3.6 days. No anastomotic leakage or pulmonary/abdominal infections occurred after operation. A total of 5.0 ± 4.0 lymph nodes .......

Discussion

With the improvement in surgical skills and the advancement in surgical equipment, especially the development of visualization devices, robotic surgery is often considered a reasonable choice for complex procedures, such as lateral pelvic lymph node dissection⁷. Reduced-port laparoscopic surgery is an emerging procedure, characterized by reduced incision number and size, making the operation less invasive than traditional laparoscopic surgery⁸. In 2016, Inaki

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
antibacterial polydioxanone	Johnson & Johnson	8622H,SXPP1A403
Laparoscopic system	STORZ	26003BA
Ring stapler	Johnson & Johnson	CDH29A
Straight cut closure	Johnson & Johnson	EC45A
Trocar	Johnson & Johnson	B5LT,B11LT,B12LT