CRCM  Vol.2 No.7 , October 2013
3-Port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance
ABSTRACT
Introduction: To present the initial experience of 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance by using a toothed oval clamp. Case Presentation: One patient received 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance by using a toothed oval clamp. Better direct vision and exposure could be acquired for performing laparoscopic surgical procedure, avoiding additional port inserted. Using this procedure, with strictly adhering to the principles of laparoscopic colectomy and oncological procedure, along with the specimen exteriorized via recta, transacted and a stapled anastomosis performed, no incision can be achieved at the end of an operation. The operative time was 180 minutes. The estimated blood loss in the course of an operation was 80 ml. The patient recovered quickly after surgery, with no post-operative pain and no incision. The patient was dischanged home on the 6th postoperative day. Conclusions: With a transrectal assistance by using a toothed oval clamp, 3-port laparoscopic surgery for rectal cancer could be achieved without no incision at the end of the operation, the same as NOTES. It is enormously advantageous to the patient and suitable for application in developing countries, especially in a rural area.


Cite this paper
Zhang, L. , Zhang, G. , Wang, P. , Wang, Y. , Song, Y. , Zou, H. and Tang, L. (2013) 3-Port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance. Case Reports in Clinical Medicine, 2, 386-389. doi: 10.4236/crcm.2013.27103.
References
[1]   Bonjer, H.J., Hop, W.C., Nelson, H., Sargent, D.J., Lacy, A.M., Castells, A., Guillou, P.J., Thorpe, H., Brown, J., Delgado, S., Kuhrij, E., Haglind, E. and Pahlman, L. (2007) Transatlantic laparoscopically assisted vs open colectomy trials study group. Laparoscopically assisted vs open colectomy for colon cancer: A meta-analysis. Archives of Surgery, 142, 298-303.
http://dx.doi.org/10.1001/archsurg.142.3.298

[2]   Nelson, H., Sargent, D.J., Wieand, H.S., Fleshman, J., Anvari, M., Stryker, S.J., Beart Jr., R.W., Hellinger, M., Flanagan Jr., R., Peters, W. and Ota, D. (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. The New England Journal of Medicine, 350, 2050-2059.
http://dx.doi.org/10.1056/NEJMoa032651

[3]   Laurent, C., Leblanc, F., Bretagnol, F., Capdepont, M. and Rullier, E. (2008) Long-term wound advantages of the laparoscopic approach in rectal cancer. British Journal of Surgery, 95, 903-908.
http://dx.doi.org/10.1002/bjs.6134

[4]   Wexner, S.D., Reissman, P., Pfeifer, J., Bernstein, M. and Geron, N. (1996) Laparoscopic colorectal surgery: Analysis of 140 cases. Surgical Endoscopy, 10, 133-136.
http://dx.doi.org/10.1007/BF00188358

[5]   Okabayashi, K., Hasegawa, H., Watanabe, M., Nishibori, H., Ishii, Y., Hibi, T. and Kitajima, M. (2007) Indications for laparoscopic surgery for Crohn’s disease using the Vienna classification. Colorectal Disease, 9, 825-829.
http://dx.doi.org/10.1111/j.1463-1318.2007.01294.x

[6]   Hildebrandt, U., Kessler, K., Plusczyk, T., Pistorius, G., Vollmar, B. and Menger, M.D. (2003) Comparison of surgical stress between laparoscopic and open colonic resections. Surgical Endoscopy and Other Interventional Techniques, 17, 242-246.
http://dx.doi.org/10.1007/s00464-001-9148-9

[7]   Whiteford, M.H., Denk, P.M. and Swanstrom, L.L. (2007) Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surgical Endoscopy and Other Interventional Techniques, 21, 1870-1874. http://dx.doi.org/10.1007/s00464-007-9552-x

[8]   Sylla, P. (2010) Current experience and future directions of completely NOTES colorectal resection. World Journal of Gastrointestinal Surgery, 2, 193-198.
http://dx.doi.org/10.4240/wjgs.v2.i6.193

[9]   Rieger, N.A. and Lam, F.F. (2010) Single-incision laparoscopically assisted colectomy using standard laparoscopic instrumentation. Surgical Endoscopy and Other Interventional Techniques, 24, 888-890.
http://dx.doi.org/10.1007/s00464-009-0683-0

[10]   Fleshman, J., Sargent, D.J., Green, E., Anvari, M., Stryker, S.J., Beart Jr., R.W., Hellinger, M., Flanagan Jr., R., Peters, W. and Nelson, H. (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study group trial. Annals of Surgery, 246, 655-662.
http://dx.doi.org/10.1097/SLA.0b013e318155a762

[11]   Jayne, D.G., Thorpe, H.C., Copeland, J., Quirke, P., Brown, J.M. and Guillou, P.J. (2010) Five-year follow-up of the medical research council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. British Journal of Surgery, 97, 1638-1645.
http://dx.doi.org/10.1002/bjs.7160

[12]   Leung, K.L., Kwok, S.P., Lam, S.C., Lee, J.F., Yiu, R.Y., Ng, S.S., Lai, P.B. and Lau, W.Y. (2004) Laparoscopic resection of rectosigmoid carcinoma: Prospective randomized trial. The Lancet, 363, 1187-1192.
http://dx.doi.org/10.1016/S0140-6736(04)15947-3

[13]   Mukai, M., Sekido, Y., Fukumitsu, H., Izumi, H., Hoshikawa, T., Tajima, T., Tobita, K., Sadahiro, S., Yasuda, S. and Ogoshi, K. (2011) Anal function-preserving subtotal intersphincteric resection/partial external sphincteric resection with hybrid 2-port hand-assisted laparoscopic surgery (Mukai’s operation) for very low stage I rectal cancer: A case report. Oncology Letters, 2, 801-805.
http://dx.doi.org/10.3892/ol.2011.327

[14]   Marescaux, J., Dallemagne, B., Perretta, S., Wattiez, A., Mutter, D. and Coumaros, D. (2007) Surgery without scars: Report of transluminal cholecystectomy in a human being. Archives of Surgery, 142, 823-827.
http://dx.doi.org/10.1001/archsurg.142.9.823

 
 
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