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Akuta S, Hirano Y, Ishiyama Y, Yamato M, Kinugasa Y. Single-incision robot-assisted surgery for colon cancer dissection with the da Vinci Xi system - a video vignette. Colorectal Dis 2024; 26:1078-1079. [PMID: 38429633 DOI: 10.1111/codi.16931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 03/03/2024]
Affiliation(s)
- Sohei Akuta
- Saitama Medical University International Medical Center Gastrointestinal Surgery, Hidaka, Saitama, Japan
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasumitsu Hirano
- Saitama Medical University International Medical Center Gastrointestinal Surgery, Hidaka, Saitama, Japan
| | - Yasuhiro Ishiyama
- Saitama Medical University International Medical Center Gastrointestinal Surgery, Hidaka, Saitama, Japan
| | - Misuzu Yamato
- Saitama Medical University International Medical Center Gastrointestinal Surgery, Hidaka, Saitama, Japan
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Kinugasa
- Saitama Medical University International Medical Center Gastrointestinal Surgery, Hidaka, Saitama, Japan
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Sueda T, Tei M, Mori S, Nishida K, Yasuyama A, Yoshikawa Y, Nomura M, Koga C, Miyagaki H, Tsujie M, Akamaru Y. Single-incision laparoscopic surgery for intestinal intussusception due to neuroendocrine tumor. Surg Case Rep 2023; 9:56. [PMID: 37031336 PMCID: PMC10082881 DOI: 10.1186/s40792-023-01639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/02/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Small intestinal neuroendocrine tumor (NET) is uncommon, but intestinal intussusception caused by NET is even rare. We report a rare case of single-incision laparoscopic surgery (SILS) for intestinal intussusception due to NET G1. CASE PRESENTATION A 72-year-old woman presented with vomiting, diarrhea, and abdominal pain. Contrast-enhanced computed tomography (CT) revealed the target sign in the ascending colon. An enhanced nodule was detected at the lead point, leading us to suspect a tumor. Colonoscopy showed a tumor at the lead point of the intestinal intussusception. Histological findings led to a diagnosis of NET G1. Single-incision laparoscopic ileocecal resection with regional lymphadenectomy was then performed. The patient was discharged 10 days postoperatively with no complications. CONCLUSION We achieved SILS with regional lymphadenectomy for preoperatively diagnosed intestinal intussusception due to NET G1. Although this condition is rare, surgeons should take this possibility into consideration in cases showing similar findings.
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Affiliation(s)
- Toshinori Sueda
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan.
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Soichiro Mori
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Kentaro Nishida
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Akinobu Yasuyama
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Yukihiro Yoshikawa
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Masatoshi Nomura
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Chikato Koga
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Hiromichi Miyagaki
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Masanori Tsujie
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
| | - Yusuke Akamaru
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai City, Osaka, 591-8025, Japan
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Comparison of robotic reduced-port and laparoscopic approaches for left-sided colorectal cancer surgery. Asian J Surg 2023; 46:698-704. [PMID: 35778241 DOI: 10.1016/j.asjsur.2022.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/OBJECTIVE The reduced-port approach can overcome the limitations of single-incision laparoscopic surgery while maintaining its advantages. Here, we compared the effects of robotic reduced-port surgery and conventional laparoscopic approaches for left-sided colorectal cancer. METHODS Between January 2015 and December 2016, the clinicopathological characteristics and treatment outcomes of 17 patients undergoing robotic reduced-port surgery and 49 patients undergoing laparoscopic surgery for left-sided colorectal cancer were compared. RESULTS The two groups were comparable in almost all outcome measures except for the distal resection margin, which was significantly longer in the laparoscopic group (P < 0.001). The between-group differences in reoperation, incisional hernia development, and overall and progression-free survival were nonsignificant; however, the total hospital cost was significantly higher in the robotic group than in the laparoscopic group (US$13779.6 ± US$3114.8 vs. US$8556.3 ± US$2056.7, P < 0.001). CONCLUSION Robotic reduced-port surgery for left-sided colorectal cancer is safe and effective but more expensive with no additional benefit compared with the conventional laparoscopic approach. This observation warrants further evaluation.
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Tei M, Suzuki Y, Sueda T, Iwamoto K, Naito A, Nomura M, Yoshikawa Y, Ohtsuka M, Imasato M, Mizushima T, Akamatsu H. Comparison of clinical outcomes of single-incision versus multi-port laparoscopic surgery for descending colon cancer: a propensity score-matched analysis. BMC Gastroenterol 2022; 22:511. [PMID: 36494780 PMCID: PMC9738018 DOI: 10.1186/s12876-022-02597-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The clinical impact of single-incision laparoscopic surgery (SILS) for descending colon cancer (DCC) is unclear. The aim of this study was to evaluate the clinical outcomes of SILS for DCC compared with multi-port laparoscopic surgery (MPLS). METHODS We retrospectively analyzed 137 consecutive patients with stage I-III DCC who underwent SILS or MPLS at two high-volume multidisciplinary tertiary hospitals between April 2008 and December 2018, using propensity score-matched analysis. RESULTS After propensity score-matching, we enrolled 88 patients (n = 44 in each group). SILS was successful in 97.7% of the matched cohort. Compared with the MPLS group, the SILS group showed significantly less blood loss and a greater number of harvested lymph nodes. Morbidity rates were similar between groups. Recurrence pattern did not differ between groups. No significant differences were found between groups in terms of 3-year disease-free and overall survivals. CONCLUSION SILS appears safe and feasible and can provide satisfactory oncological outcomes for patients with DCC.
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Affiliation(s)
- Mitsuyoshi Tei
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Yozo Suzuki
- grid.417245.10000 0004 1774 8664Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Toshinori Sueda
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Kazuya Iwamoto
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Atsushi Naito
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masatoshi Nomura
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Yukihiro Yoshikawa
- grid.417001.30000 0004 0378 5245Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, 591-8025 Japan
| | - Masahisa Ohtsuka
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Mitsunobu Imasato
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Tsunekazu Mizushima
- grid.416980.20000 0004 1774 8373Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Osaka Minato Central Hospital, Osaka, Japan
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Li FH, Zeng DX, Chen L, Xu CF, Tan L, Zhang P, Xiao JW. Comparison of clinical efficacy of single-incision and traditional laparoscopic surgery for colorectal cancer: A meta-analysis of randomized controlled trials and propensity-score matched studies. Front Oncol 2022; 12:997894. [PMID: 36324593 PMCID: PMC9621120 DOI: 10.3389/fonc.2022.997894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Single-incision laparoscopy surgery (SILS) is a new laparoscopic technique that has emerged in the past decade. Whether it has advantages over conventionl laparoscopy surgery (CLS) is inconclusive. This article aimed to compare the short- and long-term outcomes of single-incision laparoscopic surgery and conventional laparoscopic surgery for colorectal cancer through high-quality literature text mining and meta-analysis. Methods Relevant articles were searched on the PubMed, Embase, and Cochrane Library databases from January 2012 to November 2021. All data was from randomized controlled trials (RCTs) in order to increase the confidence of the analytical results.The main outcomes were intraoperative and postoperative complications. Results A total of 10 RCTs were included, involving 1609 patients. The quality of the included studies was generally high. No significant difference was found between SILS and CLS in the postoperative complications, operation time, postoperative hospital stay, number of lymph nodes removed, readmission, reoperation, complication level I- II, complication level IIIa, complication level IIIb, prolonged Ileus, blood loss, infection, anastomotic leakage and operation time. The results showed that SILS group had a higher rate of intraoperative complications, but it had lower incision length and better cosmetic effects. Conclusion These results indicate that SILS did not have a comprehensive and obvious advantage over the CLS. On the contrary, SILS has higher intraoperative complications, which may be related to the more difficulty of SILS operation, but SILS still has better cosmetic effects, which is in line with the concept of surgical development. Therefore, the SILS needs to be selected in patients with higher cosmetic requirements and performed by more experienced surgeons.
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Tei M, Suzuki Y, Ohtsuka M, Iwamoto K, Naito A, Imasato M, Mizushima T, Akamatsu H. Clinical outcomes of single incision laparoscopic surgery for colorectal cancer: A propensity score-matched analysis between well-experienced and novice surgeons. Ann Gastroenterol Surg 2022; 7:102-109. [PMID: 36643373 PMCID: PMC9831886 DOI: 10.1002/ags3.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/14/2022] [Indexed: 01/18/2023] Open
Abstract
Background Single incision laparoscopic surgery (SILS) is a recent advancement in minimally invasive techniques for colorectal cancer (CRC). However, SILS is a technically challenging procedure for novice surgeons. The aim of this study was to evaluate clinical outcomes of SILS for CRC performed by novice surgeons compared with those performed by well-experienced surgeons. Methods We retrospectively analyzed 1004 consecutive patients with stage I-IV CRC who underwent SILS between May 2009 and December 2018, using propensity score-matched analysis. Results After propensity score-matching, we enrolled 344 patients (n = 172 in each group). Before matching, significant group-dependent differences were observed in terms of age (P = 0.034) and tumor location (P < 0.001). After matching, preoperative clinical factors were similar between groups, but operative time was longer in the Novice group (213 vs 171 min, P < 0.001). Other operative factors and morbidity rates did not differ significantly between groups. The number of harvested lymph nodes was smaller in the Novice group (23 vs 25, P = 0.040), and the number of patients with lymph node metastases was smaller in the Novice group (57 vs 86, P = 0.002). The 3-year disease-free survival rate was 85.8% in the Novice group and 89.9% in the Experienced group (P = 0.512). Three-year overall survival rate was 92.2% in the Novice group and 90.0% in the Experienced group (P = 0.899). Conclusion SILS for CRC was safely performed by novice surgeons under the guidance of well-experienced surgeons, and could provide satisfactory oncological outcomes.
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Affiliation(s)
| | - Yozo Suzuki
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | | | | | - Atsushi Naito
- Department of SurgeryOsaka Police HospitalOsakaJapan
| | | | | | - Hiroki Akamatsu
- Department of SurgeryOsaka Minato Central HospitalOsakaJapan
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Tei M, Suzuki Y, Ohtsuka M, Iwamoto K, Naito A, Imasato M, Mizushima T, Akamatsu H. Comparison of clinical outcomes of single-incision versus multi-port laparoscopic surgery for rectosigmoid or upper rectal cancer. Int J Colorectal Dis 2022; 37:1553-1560. [PMID: 35639124 DOI: 10.1007/s00384-022-04166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) for rectal cancer is technically challenging, and its clinical impact is unclear. The aim of this study was to evaluate clinical outcomes of SILS for rectal cancer compared with multi-port laparoscopic surgery (MPLS). PATIENTS AND METHODS We retrospectively analyzed 357 consecutive patients with stage I-III rectal cancer located in the rectosigmoid or upper rectum who underwent SILS or MPLS between January 2012 and December 2016, using propensity score-matched analysis. RESULTS After propensity score-matching, we enrolled 204 patients (n = 102 per group). Before matching, significant group-dependent differences were observed in tumor location (p < 0.001). After matching, preoperative clinical factors were similar between groups. SILS was successful in 73.5% of cases, an additional port was required in 23.5%, and 2.9% were converted to open surgery. Compared to the MPLS group, the SILS group showed shorter operative time (192 vs. 211 min, p = 0.015) and shorter postoperative hospital stay (9 vs. 11 days, p = 0.038). Other operative factors and morbidity rates did not differ significantly between groups. The number of harvested lymph nodes was smaller in the SILS group (24) than in the MPLS group (27, p = 0.008). Postoperative recurrence did not differ between groups, either before or after matching. No significant differences in 3-year disease-free, 3-year local recurrence-free, or 5-year overall survival were found between groups. CONCLUSIONS SILS is safe, is feasible, and offers satisfactory oncological outcomes in selected patients with rectosigmoid or upper rectal cancer.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan.
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | | | - Kazuya Iwamoto
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Atsushi Naito
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | | | | | - Hiroki Akamatsu
- Department of Surgery, Osaka Minato Central Hospital, Osaka, Japan
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Furukawa K, Asaoka T, Mikamori M, Hyuga S, Iwamoto K, Nakahara Y, Naito A, Ohtsuka M, Moon J, Imasato M, Kishi K, Mizushima T. Single-Incision Laparoscopic Cholecystectomy: a Single-Centre Experience of 1469 Cases. J Gastrointest Surg 2022; 26:831-836. [PMID: 35048257 DOI: 10.1007/s11605-021-05231-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite having once been extensively used for cosmetics or pain reduction, the use of single-incision laparoscopic cholecystectomy (SILC) has declined in recent years due to technical difficulties and a reported increase in complications. Since the introduction of SILC in 2009, our hospital has been actively involved with this technique. Our experience suggests that SILC is not a difficult procedure and can be safe and useful, with particularly excellent cosmetic outcomes. This study retrospectively details the outcomes of SILC at our hospital. METHOD Data on 1469 cases of SILC performed on a waitlist basis at Osaka Police Hospital from May 2009 to December 2020 were collected and retrospectively analysed. RESULTS The median operative time and blood loss were 96 min and 0 mL, respectively. A total of 46 patients (3.1%) required conversion surgery, including 36 needing additional ports and 10 requiring laparotomy. Intraoperative complications included common bile duct injury in 1 patient (0.07%) and right hepatic artery injury in 1 patient (0.07%), with no other organ injury. Postoperative Clavien-Dindo 3 or higher complications were observed in 18 patients (1.2%). Incisional hernias occurred in 15 patients (1.0%). The median postoperative hospital stay was 3 days. CONCLUSION This study showed that SILC can be performed safely without any increase in complications, as reported previously. Granted that it is performed safely, SILC may be a useful technique due to its superior cosmetic outcomes or pain reduction.
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Affiliation(s)
- Kenta Furukawa
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan.
| | - Tadafumi Asaoka
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Manabu Mikamori
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Satoshi Hyuga
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Kazuya Iwamoto
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Yujiro Nakahara
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Atsushi Naito
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Masahisa Ohtsuka
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Jeongho Moon
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Mitsunobu Imasato
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Tsunekazu Mizushima
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
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Tei M, Suzuki Y, Ohtsuka M, Mizushima T, Akamatsu H. Single-Incision Laparoscopic Complete Mesocolic Excision With Central Vascular Ligation for Descending Colon Cancer. Am Surg 2022:31348211068009. [DOI: 10.1177/00031348211068009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Single-incision laparoscopic complete mesocolic excision with central vascular ligation for descending colon cancer is technically challenging. Standardization of the surgical procedures is therefore needed. Methods In a Trendelenburg position with left side elevated, the sigmoid mesocolon is mobilized using a medial-to-lateral approach, and the left colic artery and inferior mesenteric vein (IMV) are divided after radical lymphadenectomy along the inferior mesenteric artery, preserving the superior rectal artery. The descending mesocolon is mobilized from the retroperitoneal planes up to the dorsal surface of the pancreas using medial and lateral approaches. Next, changing the surgical position to a reverse Trendelenburg position with left side elevated, the omental bursa is opened, and the transverse mesocolon is separated from the inferior border of the pancreas. The splenocolic ligament and lateral attachment are then divided, matching the previous medial dissection of the retroperitoneum, and the splenic flexure is fully mobilized. The IMV is divided again at the inferior border of the pancreas. The left branch of the middle colic artery is also divided. Results Forty-seven consecutive patients with DCC underwent single-incision laparoscopic CME with CVL. One patient required an additional port. Median operative time, blood loss, and number of harvested lymph nodes were 240 min (interquartile range [IQR], 195-257 min), 5 mL (IQR, 5-52 mL), and 21 (IQR, 13-29), respectively. Morbidity rate was 5.9%. Median duration of hospitalization was 9 days (IQR, 7-11 days). Conclusions Single-incision laparoscopic CME with CVL is safe and feasible for DCC.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
- Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan
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Single-port laparoscopic extended right hemicolectomy with complete mesocolic excision and central vascular ligation using a right colon rotation technique (flip-flap method). Surg Endosc 2021; 35:5359-5364. [PMID: 33978848 DOI: 10.1007/s00464-021-08500-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Single-port laparoscopic extended right hemicolectomy with complete mesocolic excision and central vascular ligation is technically challenging, and a standardized procedure is needed to minimize technical hazards. TECHNIQUE As a first step, the hepatic flexure is mobilized from the duodenum, and the third part of the duodenum and pancreatic head was exposed. Next, the ileocecal vessels are divided at the root using a medial-to-lateral approach, and the cecum is separated from the retroperitoneal space. This process completes the mobilization of the right colon. In the second step, the omental bursa is opened, and the inferior border of the pancreas is exposed. The mobilized right colon is turned around to the left of the superior mesenteric vein, continuing to separate the mesentery from right to left side, and the right colic vessels are divided at the roots. The inverted right colon is restored to its original position, and the mesenteric fat is dissected along the left edge of the superior mesenteric artery to the inferior border of the pancreas. RESULTS A total of 57 consecutive patients with advanced hepatic flexure colon cancer (n = 24) and transverse colon cancer (n = 33) underwent S-ERHC. The conversion rate to open surgery was 5.3%. Operative time, blood loss, and number of harvested lymph nodes were 232 min (interquartile range [IQR], 184-277 min), 5 mL (IQR, 5-66 mL), and 30 (IQR, 22-38), respectively. According to the Clavien-Dindo classification, the grade ≥ 2 complication rate was 10.5%. Median duration of hospitalization was 9 days (IQR, 7-13 days). CONCLUSIONS Single-port laparoscopic extended right hemicolectomy using a right colon rotation technique is safe, feasible, and useful. This technique of repeating the inversion and restoration of the right colon may help avoid bleeding and damage to other organs and facilitate reliable lymph node dissection.
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Chang TC, Lin EK, Lu YJ, Huang MT, Chen CH. Single-incision robotic colectomy versus single-incision laparoscopic colectomy: A matched case control study. Asian J Surg 2021; 44:749-754. [PMID: 33468374 DOI: 10.1016/j.asjsur.2020.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/20/2020] [Accepted: 12/20/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Single incision laparoscopic colectomy (SILC) and single incision robotic colectomy (SIRC) are both advanced minimally invasive operative techniques. However, studies comparing these two surgical methods have not been published. The purpose of this study is to compare and evaluate the short-term outcomes of SIRC with those of SILC. METHODS A total of 21 consecutive patients underwent SIRC and 136 consecutive patients underwent SILC in separate institutes between January 2013 and December 2019. We used retrospective cohort matching to analyze these patients. RESULTS Prior to matching, patients who underwent SIRC had a lower percentage of American Society of Anesthesiologists (ASA) grades III-IV (5% vs. 19%, P = 0.11) compared with patients who underwent SILC. The SIRC group revealed a higher proportion of sigmoid colon lesions and anterior resections than the SILC group (61% vs. 45%, P = 0.16). After 1:4 cohort matching, 21 patients were enrolled in the SIRC group and 84 patients were enrolled in the SILC group. No statistically significant difference in terms of operative time (SIRC: 185 ± 46 min, SILC: 208 ± 53 min; P = 0.51), estimated blood loss (SIRC: 12 ± 22 ml, SILC: 85 ± 234 ml; P = 0.12), and complications (SIRC: 4.7%, SIRC: 7.1%; P = 0.31) was observed between these groups. Length of postoperative hospital stay (SIRC: 8.3 ± 1.7 days, SILC: 9.3 ± 6.5; P = 0.10) and number of harvested lymph nodes (SIRC: 21.3 ± 10.3, SILC: 21.3 ± 9.5; P = 0.77) were also similar between the two groups. In subgroup analysis, numbers of harvested lymph node is less in SIRC than SILC (SIRC: 18.1 ± 4.7 vs. SILC: 18.9 ± 8.1, P = 0.04) in anterior resection. CONCLUSION SIRC and SILC are safe and feasible procedures with similar surgical and pathological outcomes for right- and left-side colectomy.
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Affiliation(s)
- Tung-Cheng Chang
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291 Zhongzheng Road, Zhonghe District, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - En-Kwang Lin
- Division of Colorectal Surgery, Department of Surgery, WanFang Hospital, Taipei Medical University, No.111 Sec. 3 Xinglong Rd., Wenshan Dist., Taipei, Taiwan.
| | - Yen-Jung Lu
- Division of Colorectal Surgery, Department of Surgery, WanFang Hospital, Taipei Medical University, No.111 Sec. 3 Xinglong Rd., Wenshan Dist., Taipei, Taiwan.
| | - Ming-Te Huang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Number 291 Zhongzheng Road, Zhonghe District, Taipei, Taiwan.
| | - Chien-Hsin Chen
- Division of Colorectal Surgery, Department of Surgery, WanFang Hospital, Taipei Medical University, No.111 Sec. 3 Xinglong Rd., Wenshan Dist., Taipei, Taiwan.
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Tei M, Sueda T, Matsumura T, Furukawa H, Koga C, Wakasugi M, Miyagaki H, Kawabata R, Tsujie M, Hasegawa J. Systematic review of single-port vs. multi-port surgery for rectal cancer. Mol Clin Oncol 2020; 14:24. [PMID: 33335732 DOI: 10.3892/mco.2020.2186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/07/2020] [Indexed: 12/15/2022] Open
Abstract
The aim of the current systematic review was to compare the short-term clinical and oncological outcomes of single-port surgery (SPS) to multi-port surgery (MPS) for rectal cancer in MEDLINE, PubMed and Cochrane Library from January 2010 to December 2018. A total of 5 clinical controlled studies composed one randomized pilot study and four non-randomized studies with a total of 461 patients were analyzed after a systematic review. A total of 125 patients (27.1%) underwent SPS and 336 patients (72.9%) underwent MPS for rectal cancer. The rate of conversion to open surgery was lower in the SPS group compared with the MPS group (0.8 vs. 5.4%, respectively). A total of 16.8% of patients in the SPS group required an additional port to complete the operation. The morbidity rate was lower in the SPS group compared with the MPS group (28.0 vs. 39.0%, respectively). The other short-term clinical outcomes were similar in both groups. The R0 resection rate was 99.0% in the SPS group and 98.7% in the MPS group. The oncological clearance was satisfactory and similar in both groups. The current study concluded that SPS can be performed safely and provide satisfactory oncological outcomes in patients with rectal cancer. However, further studies are required to determine the role of SPS in the long-term clinical and oncological outcomes.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Toshinori Sueda
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Tae Matsumura
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Haruna Furukawa
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Chikato Koga
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Masaki Wakasugi
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Hiromichi Miyagaki
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Ryohei Kawabata
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Masanori Tsujie
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Junichi Hasegawa
- Department of Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka 591-8025, Japan
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Hirano Y, Hiranuma C, Hattori M, Douden K, Yamaguchi S. Long-term oncological outcomes of single-port laparoscopic surgery for colon cancer. ANZ J Surg 2019; 89:408-411. [PMID: 30873699 DOI: 10.1111/ans.15076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/25/2018] [Accepted: 12/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND We retrospectively reviewed our consecutive experience from the introduction of single-port laparoscopic surgery (SPS) for colon cancer, and its 5-year oncological outcomes are evaluated. METHODS A total of 288 patients (140 males) with a mean age of 71.5 years were treated with the single-port laparoscopic colectomy for stage I, II and III colon cancers. Exclusion criteria of SPS were patients with unresolved bowel obstruction, T4b tumour, tumour perforation and severe medical illness. RESULTS In 20 patients (6.9%), we inserted an extra port mainly to transect the rectum. The median follow-up period was 52 months. The 5-year relapse-free survival rates in stage I, II and III patients were 95.8%, 80.2% and 61.6%, respectively. The 5-year overall survival rates for stage I, II and III patients were 97.4%, 85.3% and 72.9%, respectively. The 5-year cancer-specific survival rates in patients diagnosed pathologically T1, T2, T3 and T4 were 100%, 100%, 92.1% and 73.9%, respectively. CONCLUSIONS SPS colectomy can be applied to the treatment of colon cancer with good long-term oncological outcomes. However, we should pay more attention when we treat the pathologically diagnosed T4 tumours.
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Affiliation(s)
- Yasumitsu Hirano
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | | | - Kenji Douden
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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Clinical Outcome of Single-port Surgery in Patients With Pathologic T4 Colon Cancer. Surg Laparosc Endosc Percutan Tech 2019; 29:367-372. [PMID: 30839362 DOI: 10.1097/sle.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the clinical outcomes of single-port surgery (SPS), compared with those of multiport surgery (MPS) in patients with pathologic T4 colon cancer. MATERIALS AND METHODS A total of 188 patients with proven pathologic T4 colon cancer who underwent laparoscopic surgery from January 2008 to December 2014 were enrolled in this study. These patients were divided into the SPS group (n=94) and the MPS group (n=94). The clinical outcomes were compared between groups. RESULTS The median operative time was significantly shorter in the SPS group than in the MPS group (P=0.045). Postoperative complications did not differ between the groups. The length of postoperative hospital stay was significantly shorter in the SPS group than in the MPS group (P<0.001). Oncological resection rates were similar between groups. The 3-year relapse-free survival rates, the 3-year local recurrence-free survival rates, and the 5-year overall survival rates were similar between groups. CONCLUSIONS SPS is safe and feasible in patients with pathologic T4 colon cancer.
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Clinical Outcomes of Single-port Surgery for Colon Cancer in Octogenarians. Surg Laparosc Endosc Percutan Tech 2018; 28:164-169. [PMID: 29672345 DOI: 10.1097/sle.0000000000000524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM The aim of this study was to evaluate the clinical outcomes of single-port surgery for colon cancer in octogenarians. MATERIALS AND METHODS A retrospective cohort study was performed on patients who underwent single-port surgery for colon cancer from 2010 to 2014 at a single institution. Patients were categorized into the following 3 groups according to age: ≤69 years (n=196), 70 to 79 years (n=143), and ≥80 years (n=86). Short-term and long-term outcomes were assessed among 3 groups. RESULTS The rate of overall postoperative complications in the octogenarian group did not differ significantly, compared with the other groups (20.9% in the octogenarians group vs. 14.3% in the ≤69 y group and 15.4% in the 70 to 79 y group, P=0.363). The 3-year relapse-free survival rates were similar among groups (83.9% in the octogenarians group vs. 87.8% in the ≤69 y group and 87.5% in the 70 to 79 y group, P=0.754). The 5-year overall survival rates were 79.8% in the octogenarians group, 89.9% in the ≤69 years group, and 81.7% in the 70 to 79 years group (P=0.063). CONCLUSION Single-port surgery is safe, feasible, and can provide satisfactory oncological outcomes in octogenarians with colon cancer.
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Tei M, Otsuka M, Suzuki Y, Kishi K, Tanemura M, Akamatsu H. Safety and feasibility of single-port laparoscopic multivisceral resection for locally advanced left colon cancer. Oncol Lett 2018; 15:10091-10097. [PMID: 29928379 DOI: 10.3892/ol.2018.8582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/16/2018] [Indexed: 01/22/2023] Open
Abstract
The aim of the present study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (S-MVR) for locally advanced left colon cancer. S-MVR is a challenging technique and to the best of our knowledge this is the first report of S-MVR for left colon cancer invading or adhering to neighboring organs. A retrospective review was conducted of patients who underwent laparoscopic multivisceral resection for locally advanced left colon cancer invading or adhering to neighboring organs from January 2008 to December 2014. Short-term and long-term outcomes were analyzed between groups of patients who underwent S-MVR and multi-port laparoscopic multivisceral resection (M-MVR) retrospectively. A total of 14 patients underwent S-MVR and 15 patients underwent M-MVR. There were no significant differences between groups in terms of operative factors and postoperative complications. The length of hospital stay was significantly shorter in the S-MVR group compared with the M-MVR group (P=0.048). Three-year overall survival was 61.9% in the S-MVR group (n=14). In patients with stage II (P=0.600) and III (P=0714) disease the three-year overall and disease-free survival was 81.8 and 58.3% in the S-MVR group and 80.0 and 70% in the M-MVR groups over a median follow-up of 34 months. In conclusion, S-MVR for locally advanced left colon cancer is safe and feasible in selected patients.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, Osaka 543-0035, Japan
| | - Masahisa Otsuka
- Department of Surgery, Osaka Police Hospital, Osaka 543-0035, Japan
| | - Yozo Suzuki
- Department of Surgery, Osaka Police Hospital, Osaka 543-0035, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, Osaka 543-0035, Japan
| | | | - Hiroki Akamatsu
- Department of Surgery, Osaka Police Hospital, Osaka 543-0035, Japan
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Initial Experience of Single-port Laparoscopic Multivisceral Resection for Locally Advanced Colon Cancer. Surg Laparosc Endosc Percutan Tech 2018; 28:108-112. [DOI: 10.1097/sle.0000000000000508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Hirano Y, Hattori M, Douden K, Hiranuma C, Hashizume Y, Taniguchi K. Single-Incision Laparoscopic Colectomy for Colon Cancer: Experiences with 308 Consecutive Cases. Am Surg 2018. [DOI: 10.1177/000313481808400432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Single-incision laparoscopic surgery (SILS) has been developed with the aim to further reduce the invasiveness of conventional laparoscopy. Our experiences with more than 300 consecutive patients with SILS for colon cancer are reviewed, and its outcomes are evaluated to determine the midterm clinical and oncologic safety of SILS for colon cancer in a community hospital. A single surgeon's consecutive experience of SILS for colon cancer is presented. Three hundred and eight patients were treated with the SILS procedure for colon cancer between December 2010 and March 2015. Data were analyzed according to intention to treat. Of these 308 patients, 19 (6.2%) were converted to laparotomy. Intraoperative injury occurred in five patients. Postoperative complications occurred in 19 patients (6.2%). The 2-year relapse-free survival rates of patients with Stage I, Stage II, and Stage III were 97.8, 92.2, and 80.4 per cent, respectively, and the 2-year overall survival rates of patients with Stage I, Stage II, Stage III, and Stage IV were 100, 95.7, 93.0, and 74.4 per cent, respectively. Our initial experiences showed that SILS colectomy for cancer can be performed safely and with good short-term oncologic outcomes by a skilled surgeon.
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Affiliation(s)
- Yasumitsu Hirano
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan and the
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Masakazu Hattori
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan and the
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Kenji Douden
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan and the
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Chikashi Hiranuma
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan and the
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Yasuo Hashizume
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan and the
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Keizo Taniguchi
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan and the
- Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan
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Tei M, Otsuka M, Suzuki Y, Kishi K, Tanemura M, Akamatsu H. Safety and feasibility of single-port laparoscopic low anterior resection for upper rectal cancer. Am J Surg 2018; 216:1101-1106. [PMID: 29631909 DOI: 10.1016/j.amjsurg.2018.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/06/2018] [Accepted: 03/23/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Single-port surgery for rectal cancer is challenging and controversial. The aim of this study was to compare the short-term outcomes of single-port laparoscopic low anterior resection (S-LAR) to multi-port laparoscopic low anterior resection (M-LAR) for upper rectal cancer. METHODS From January 2011 to December 2015, a total of 93 patients who underwent S-LAR (n = 44) or M-LAR (n = 49) without protective diverting ileostomy for upper rectal cancer were identified. Tumors were located between the inferior margin of the second sacral vertebra and the peritoneal reflection. Short-term outcomes were compared between groups. RESULTS S-LAR was successful in 75% of cases: 25% of cases required one additional port. Operative factors, perioperative outcomes, oncological outcomes did not differ significantly between groups. In patients with stage I-III disease, the 3-year relapse-free survival rate was significantly higher in the S-LAR group than in the M-LAR group (p = 0.032). The 3-year overall survival rate was similar between groups. CONCLUSIONS S-LAR is safe, feasible and can provide satisfactory oncological outcomes in selected patients with upper rectal cancer.
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Affiliation(s)
- Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan.
| | - Masahisa Otsuka
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
| | - Yozo Suzuki
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
| | - Masahiro Tanemura
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Osaka Police Hospital, 10-31, Kitayama-cho, Tennoji-ku, Osaka City, Osaka, 543-0035, Japan
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Gibor U, Perry Z, Domchik S, Mizrahi S, Kirshtein B. Single Port and Conventional Laparoscopy in Colorectal Surgery: Comparison of Two Techniques. J Laparoendosc Adv Surg Tech A 2017; 28:65-70. [PMID: 28976805 DOI: 10.1089/lap.2017.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) was introduced to further the enhanced outcome of conventional multiport laparoscopy (CML). We compared their short- and long-term outcomes in colorectal surgery. MATERIALS AND METHODS Retrospective review of patients who underwent elective laparoscopic colorectal surgery during 3-year period. Patients' data, surgery outcomes, and oncological results were compared. RESULTS Sixty-one patients (33 male, 28 female), mean age 67.4 years, underwent laparoscopic colonic resections: 28 SILS and 33 CML. Twenty-three (37.7%) patients had previous abdominal surgery. There were 19 (31.2%) right, 9 (14.7%) left, and 2 (3.3%) total colectomies, 16 (26.2%) sigmoidectomies, 13 (21.3%) anterior and 2 (3.3%) abdominoperineal resections. Colonic malignancy was a main indication for the surgery in 51 (83.6%) patients. Mean surgery time and postoperative stay were 92.0 minutes and 9 days, respectively. Pathological examination revealed stage I colon cancer in 16 (32%), stage II in 22 (44%), stage III in 10 (20%), and stage IV in 2 (4%) patients. Mean number of retrieved lymph nodes was 19 ± 13.5. No differences were found between groups in demographic data, type of surgery, surgery time and hospital stay, pathological results and tumor staging, and disease-free and overall survivals. In the SILS group, placement of additional trocar was required in 7 (25%) and conversion in 3 (10.7%) cases compared with 1 (3%) case of conversion to formal laparotomy in the CML group. Overall postoperative morbidity was 16.4%. There was no mortality in both the groups. During the study period, 3 patients from the CML group had cancer recurrence. CONCLUSIONS SILS is a feasible and safe technique compared with CML in terms of surgical and oncological outcomes.
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Affiliation(s)
- Udit Gibor
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Zvi Perry
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Sergey Domchik
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Solly Mizrahi
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Boris Kirshtein
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva, Israel
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Choi BJ, Jeong WJ, Kim SJ, Lee SC. Impact of obesity on the short-term outcomes of single-port laparoscopic colectomy for colorectal cancer in the Asian population: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e6649. [PMID: 28700463 PMCID: PMC5515735 DOI: 10.1097/md.0000000000006649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Single-port laparoscopic surgery (SPLS) is being increasingly performed for treating colorectal cancer. Here, we aimed to assess the safety and feasibility of SPLS for colorectal cancer in obese patients through a comparison of their short-term outcomes with those of nonobese patients.A total of 323 patients who underwent SPLS for colorectal cancer at our center between March 2009 and August 2014 were enrolled. The outcomes were analyzed according to the body mass index (BMI) category: nonobese (BMI < 25), obese I (BMI: 25.0-29.9), and obese II (BMI ≥ 30).Of the 323 patients, 233 (72.1%), 80 (24.8%), and 10 (3.1%), were assigned to the nonobese, obese I, and obese II groups, respectively. The clinicopathologic patient characteristics, such as age, gender, tumor location, and previous laparotomy, were similar among the 3 groups. The mean operative time (nonobese vs obese I vs and obese II groups: 269.2 vs 270.4 vs 342.8 minutes, respectively) and estimated surgical blood loss (277.7 vs 260.5 vs 387.0 mL, respectively) were greater in the obese II group than in the nonobese and obese I groups, although the difference was not significant (P = .247 and P = .205, respectively). However, the time to passage of flatus significantly differed among the groups (P = .040); in particular, this value was significantly longer in the obese II group than in the obese I group (P = .031). None of the other parameters, including conversion to open or conventional laparoscopic surgery and intra- and postoperative morbidity, significantly differed among the 3 groups.SPLS for colorectal cancer can be safely performed in obese Asian patients with equivalent short-term outcomes as compared with that in nonobese patients. Hence, SPLS can be safely recommended for colorectal cancer in obese patients if the surgeon is experienced. Nevertheless, the technique used warrants further investigation, and a large-scale prospective study is required.
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Abu Gazala M, Wexner SD. Re-appraisal and consideration of minimally invasive surgery in colorectal cancer. Gastroenterol Rep (Oxf) 2017; 5:1-10. [PMID: 28567286 PMCID: PMC5444240 DOI: 10.1093/gastro/gox001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 12/13/2022] Open
Abstract
Throughout history, surgeons have been on a quest to refine the surgical treatment options for their patients and to minimize operative trauma. During the last three decades, there have been tremendous advances in the field of minimally invasive colorectal surgery, with an explosion of different technologies and approaches offered to treat well-known diseases. Laparoscopic surgery has been shown to be equal or superior to open surgery. The boundaries of laparoscopy have been pushed further, in the form of single-incision laparoscopy, natural-orifice transluminal endoscopic surgery and robotics. This paper critically reviews the pathway of development of minimally invasive surgery, and appraises the different minimally invasive colorectal surgical approaches available to date.
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Affiliation(s)
- Mahmoud Abu Gazala
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D. Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Wakasugi M, Tei M, Anno K, Mikami T, Tsukada R, Koh M, Furukawa K, Suzuki Y, Masuzawa T, Kishi K, Tanemura M, Akamatsu H. Single-incision totally extraperitoneal inguinal hernia repair is safe and feasible in elderly patients: A single-center experience of 365 procedures. Asian J Endosc Surg 2016; 9:281-284. [PMID: 27188648 DOI: 10.1111/ases.12298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/23/2016] [Accepted: 04/08/2016] [Indexed: 11/27/2022]
Abstract
The aim of this study was to evaluate the feasibility and safety of SILS for totally extraperitoneal inguinal hernia repair in elderly patients. A retrospective analysis of 365 patients who underwent of SILS for totally extraperitoneal inguinal hernia repair from January 2012 to November 2015 at Osaka Police Hospital was performed, and the outcomes of patients aged <80 years and those aged ≥80 years were compared. There was a greater proportion of patients with an ASA score ≥3 among those ≥80 years than among those <80 years. The mean operative time for unilateral inguinal hernia was 94 min in patients <80 years and 98 min in patients ≥80 years. The mean operative time for bilateral inguinal hernia was 133 min in patients <80 years and 130 min in patients ≥80. Intraoperative bleeding was minimal in all patients. Conversion to a different operative procedure occurred in 3% (10/322) of patients <80 years and in 5% (2/43) of patients ≥80 years (P = 0.6). The mean postoperative hospital stay was 2.2 days for patients <80 years and 2.2 days for patients ≥80 years. The mean follow-up period 21 ± 14 months (range, 3-50 months) for patients <80 years and 17 ± 14 months (range, 3-50 months) for patients ≥80 years (P = 0.3). Postoperative complications were seen in 12% (38/322) of patients <80 years and in 14% (6/43) of patients ≥80 years (P = 0.7). A seroma was seen in 9% (28/322) of patients <80 years and in 12% (5/43) of patients ≥80 years (P = 0.6). A wound infection occurred in 2% (8/322) of patients <80 years. These seromas and wound infections were managed conservatively. Pulmonary embolism was seen in one patient <80 years (0.3%). There was no mortality or recurrence in either group. SILS for totally extraperitoneal inguinal hernia repair has good cosmesis and can be performed in elderly patients with acceptable morbidity and mortality.
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Affiliation(s)
| | - Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Kana Anno
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Tsubasa Mikami
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Ryo Tsukada
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masahiro Koh
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Kenta Furukawa
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yozo Suzuki
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Toru Masuzawa
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
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Perioperative and short-term oncological outcomes of single-port surgery for transverse colon cancer. Surg Today 2016; 47:676-682. [DOI: 10.1007/s00595-016-1425-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/01/2016] [Indexed: 01/25/2023]
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25
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Song JM, Kim JH, Lee YS, Kim HY, Lee IK, Oh ST, Kim JG. Reduced port laparoscopic surgery for colon cancer is safe and feasible in terms of short-term outcomes: comparative study with conventional multiport laparoscopic surgery. Ann Surg Treat Res 2016; 91:195-201. [PMID: 27757397 PMCID: PMC5064230 DOI: 10.4174/astr.2016.91.4.195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/01/2016] [Accepted: 06/21/2016] [Indexed: 02/08/2023] Open
Abstract
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.
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Affiliation(s)
- Ju Myung Song
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Suk Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Young Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyu Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Teak Oh
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Gi Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wakasugi M, Tei M, Omori T, Anno K, Mikami T, Tsukada R, Koh M, Gakuhara A, Furukawa K, Suzuki Y, Masuzawa T, Kishi K, Tanemura M, Akamatsu H. Single-incision laparoscopic surgery as a teaching procedure: a single-center experience of more than 2100 procedures. Surg Today 2016; 46:1318-24. [PMID: 26922213 DOI: 10.1007/s00595-016-1315-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/26/2016] [Indexed: 12/19/2022]
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Wakasugi M, Tei M, Anno K, Mikami T, Tsukada R, Koh M, Furukawa K, Suzuki Y, Masuzawa T, Kishi K, Tanemura M, Akamatsu H. Single-incision totally extraperitoneal inguinal hernia repair as a teaching procedure: one center's experience of more than 300 procedures. Surg Today 2015; 46:1039-44. [PMID: 26563226 DOI: 10.1007/s00595-015-1273-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/20/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate resident doctors' proficiency in performing single-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair (SILS-TEP), and assess patient outcomes by comparing procedures performed by resident surgeons vs. those performed by staff surgeons. METHODS We analyzed retrospectively 301 patients who underwent SILS-TEP between January 2011 and May 2015 at Osaka Police Hospital. RESULTS The mean operative times for unilateral and bilateral hernia repairs in the resident-surgeon and the staff-surgeon groups were 99 vs. 88 min, respectively (p < 0.05), and 130 vs. 137 min, respectively. There was no significant difference in the incidence of conversion to a different procedure between the groups. The mean postoperative hospital stay was 2.0 days for patients from the resident-surgeon group vs. 2.8 days for those from the staff-surgeon group (p < 0.05). Seromas and wound infections developed in 8 % (12/148) of patients from the resident-surgeon group vs. 12 % (19/153) of those from the staff-surgeon group. No other major complications or hernia recurrence were noted in either group. CONCLUSIONS SILS-TEP was performed safely, with low morbidity and no recurrence, by the resident surgeons under appropriate guidance by staff surgeons.
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Affiliation(s)
- Masaki Wakasugi
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan.
| | - Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Kana Anno
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Tsubasa Mikami
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Ryo Tsukada
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Masahiro Koh
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Kenta Furukawa
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Yozo Suzuki
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Toru Masuzawa
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Masahiro Tanemura
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
| | - Hiroki Akamatsu
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoujiku, Osaka, 543-0035, Japan
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