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Surgical Endoscopy

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01-02-2019

Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer

Authors: Daiki Yasukawa, Tomohide Hori, Yoshio Kadokawa, Shigeru Kato, Yuki Aisu, Suguru Hasegawa

Published in: Surgical Endoscopy | Issue 2/2019

Abstract

Background

Laparoscopic abdominoperineal resection (APR) for low rectal cancer (LRC) is performed worldwide. However, APR involves technical difficulties and often causes intractable perineal complications. Therefore, a novel and secure technique during APR is required to overcome these critical issues. Although the usefulness of the endoscopic trans-anal approach has been documented, no series of the endoscopic trans-perineal approach during laparoscopic APR for LRC has been reported.

Methods

Trans-perineal minimally invasive surgery (TpMIS) has been used during laparoscopic APR in our institution since April 2014. TpMIS is defined as an endoscopic trans-perineal approach using a single-port device and laparoscopic instruments. In this study, we retrospectively evaluated 50 consecutive patients with LRC who underwent laparoscopic APR at our institution from February 2011 to June 2017 and compared the outcomes of the patients who underwent TpMIS [trans-perineal APR (TpAPR) group, n = 21] versus the conventional trans-perineal approach (conventional group, n = 29). We investigated our experiences with TpMIS in detail and evaluated the safety and utility of TpMIS for patients with LRC. Moreover, major features and difficulties of TpMIS were examined from a surgical viewpoint.

Results

Intraoperative blood loss (median (range) 55 (10–600) vs. 120 (20–1650) ml) and severe perineal wound infection (Clavien–Dindo grade 3, 0 vs. 5 cases) were significantly lower in the TpAPR than conventional group. TpMIS led to a shortened hospital stay (median (range), 14 (10–74) vs. 23 (10–84) days), and neither mortality nor conversion to open surgery occurred in the TpAPR group.

Conclusions

Magnified visualization via endoscopy provided more accurate dissection and less blood loss during surgery. Minimal skin incisions enabled a reduction in postoperative perineal complications, and consequently shortened the hospital stay. TpMIS during laparoscopic APR is safe and beneficial for patients with LRC.

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Title: Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer
Authors: Daiki Yasukawa
Tomohide Hori
Yoshio Kadokawa
Shigeru Kato
Yuki Aisu
Suguru Hasegawa
Publication date: 01-02-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6316-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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