A novel single-port laparoscopic operation for colorectal cancer with transanal specimen extraction: a comparative study

Abstract

Background: Extension of a single incision for the purpose of specimen extraction in single-port laparoscopic surgery (SPLS) can undermine the merits of SPLS, either by hurting cosmesis or by increasing wound morbidity.

Methods: We retrospectively analyzed the clinical outcomes of patients undergoing SPLS sigmoidectomy, either with transanal specimen extraction (TASE, n = 15) or transumbilical specimen extraction (TUSE, n = 68), for colorectal cancer between March 2009 and March 2013. The inclusion criterion was a tumor diameter of ≤ 5 cm. The median follow-up was 93 months (range 13 - 149).

Results: Most of intraoperative and postoperative variables were comparable between the two groups, except for lengthening of operation time in TASE (287 ± 87 min vs. 226 ± 78 min, P = 0.011). TUSE did not lengthen the duration of postoperative recovery, hospital stay, or pain, or increase the incidence of postoperative complications. Whereas TUSE showed 8.8% (6/68) of wound-related complications, TASE did not show wound-related complications during follow-up period (P = 0.586).

Conclusion: With the exception of a prolonged operation time, TASE showed equivalent surgical outcomes as TUSE in SPLS sigmoidectomy. Thus, the implement of TASE is expected to provide one way of reducing wound-related complications in SPLS in patients with a tumor diameter of ≤5 cm.

Figure 1

Patient allocation.

Figure 2

Placement of single-ports in the umbilicus. A Placement of homemade glove port composed of a wound retractor (ALEX wound retractor; XS, USA), a surgical glove, and two pipes (threaded cannulas and seals 5 mm; Applied Medical, USA). B Placement of a commercially ready-made single port (OCTO port; Dalim, Korea).

Figure 3

Operative illustrations showing single-port laparoscopic colectomy with transanal specimen extraction (TASE). After dissection, both ends of the tumor-bearing segment were bound with tape, and the proximal end was divided by End-GIA. A The distal end of the tumor-bearing segment was identified. The white arrow indicates the direction to the rectum. The red arrow indicates the tumor-bearing segment. The dotted line indicates the planed resection line. B The tumor-bearing segment was completely resected by dividing the distal end. C An anal trocar was entered into the pelvic cavity via the anus. D An anvil with an anchor suture was entered into the pelvic cavity through the anal trocar. E The anvil was introduced into the remaining colon and was fixed by purse-string suture. F, G Thereafter, the specimen was retrieved through the anal trocar. H Lastly, end-to-end colorectal anastomosis was performed with a transanally inserted circular stapler (EEA 28 mm or 31 mm; Ethicon, USA).

Figure 4

Prerequisites of transanal specimen extraction using our method. A Anal trocars. They are metal cylinders with a range of diameters (3–6 cm) that are designed for specimen extraction via the anal canal. B An anvil with an anchor suture. The tip of the anvil was anchored with the aim of facilitating an intracorporeal purse-string suture.

Figure 5

The changes in the operative times of the TASE (transanal specimen extraction) group following single-port anterior resection (A) and low anterior resection (B).

Figure 6

Representative illustrations of postoperative wounds. A Postoperative wound following transumbilical specimen extraction (TUSE). B Postoperative wound following transanal specimen extraction (TASE).