Extraperitoneal approach to left-sided colorectal resections (EXPERTS procedure)

An extraperitoneal single-port robotic approach to low anterior resection-Cadaveric experience

AIM

A minimally invasive surgery (MIS) extraperitoneal (XP) approach to left-sided colorectal resection utilizing the laparoscopic approach has recently been shown to be safe and feasible and to have potential advantages over the transperitoneal approach, especially in high-risk surgical patients. The aim of this article is to provide a first cadaveric demonstration of the use of a single-port robotic platform in performing XP low anterior resection by MIS.

METHOD

A single-port robotic platform (DaVinci®SP™) was used to perform XP single-port low anterior resection in two cadavers with body mass indexes (BMIs) of 19 and 40 kg/m2.

RESULTS

The single-port robotic platform with versatile arms was successfully used to perform a complete low anterior resection with splenic flexure mobilization and total mesorectal excision through a single port.

CONCLUSIONS

A single-port robotic platform enhances complete XP dissection in the supine patient in extreme BMI ranges. Clinical studies are necessary to confirm these findings.

[Primary retroperitoneal approach for vessel-sparing D3-lymph node dissection in left colonic and rectal cancer resections - the first Russian experience]

OBJECTIVE

To develop and describe a technique of primary retroperitoneal approach for vessel-sparing D3-lymph node dissection in the left colon and rectal cancer surgery; to evaluate the short-term results of the first series of patients treated with a new minimally invasive method.

MATERIAL AND METHODS

The first 10 patients with adenocarcinoma of the left colon and rectum, who underwent surgical treatment using the retroperitoneal approach with vessel-sparing D3 lymph node dissection, were included in the study. The primary retroperitoneal approach involved mobilization of the left side of the colon, D3 lymph node dissection with skeletonization of inferior mesenteric artery (IMA) and selective ligation of afferent vessels from retroperitoneal space using SILS access system at the first steps of surgery. Intersection of visceral and parietal peritoneum, as well as intersection of mesentery within the bowel resection borders was performed laparoscopically. Surgical specimen was removed through retroperitoneal access incision.

RESULTS

Duration of retroperitoneal stage with lymph node dissection was 100 min (70.0-115.0). There were 28.5 (22-37) regional lymph nodes removed during vessel-sparing D3 lymph node dissection with IMA skeletalization, 3 (1-4) metastatic regional lymph nodes and 3.5 (2-5) apical nodes. In 4 out of 10 patients, we damaged visceral peritoneum during retroperitoneal dissection. Two patients developed Clavien-Dindo grade 1-2 complications. Mean postoperative hospital stay was 8 days (5-12).

CONCLUSION

We developed retroperitoneal vessel-sparing D3 lymph node dissection for the treatment of left colon and rectal cancer. Initial results demonstrated safety and feasibility of this approach.