Department of Colorectal Surgery, Saku Central Hospital, Saku-City, Nagano, Japan.
Dis Colon Rectum. 2011 May;54(5):632-7. doi: 10.1007/DCR.0b013e3182093c68.
Single-access laparoscopic surgery was first introduced for colectomy and later adapted for anterior resection. During single-access laparoscopic pelvic procedures, such as total mesorectal excision, it is often difficult to obtain an adequate operative field. By suspending the rectum vertically, we were able to execute a total mesorectal excision with single-access laparoscopy. We describe here the use of this new procedure to treat rectal cancer.
The selected 7 patients (1 male and 6 female) with stage II or III rectal cancer underwent the procedure. Single-port access to the abdomen was provided by a 3.0-cm incision at the right iliac fossa. The descending mesocolon was dissected by use of a medial approach, and a columnar magnet was placed on the surface of the abdominal wall to restore triangulation. The inferior mesenteric artery was skeletonized and the superior rectal artery divided during lymph node dissection. The total mesorectal excision extended to the pelvic floor and the rectum was vertically retracted with a suspending bar in collaboration with an extracorporeal magnet tool. The rectum was then transected below the reflection of the peritoneum. Intracorporeal anastomosis was performed with the double-stapling technique. Two pelvic drains were inserted through the single incision and the anus, respectively, for all patients. A defunctioning ileostomy was not created in any patient.
Median total surgical time was 205 minutes (range, 175-245 min). Intraoperative blood loss was minimal in all patients (range, 1-20 mL). None of the cases required conversion to open surgery or addition of a second port. The only preoperative or postoperative complication occurred in one patient with clinical anastomotic leakage.
Low anterior single-access laparoscopic resection seems safe and feasible when the rectum is suspended like a swing to ensure an adequate operative field.
单一切口腹腔镜手术最初用于结肠切除术，后来也适用于前切除术。在单一切口腹腔镜盆腔手术中，如全直肠系膜切除术，往往难以获得足够的手术视野。通过将直肠垂直悬吊，我们能够用单一切口腹腔镜进行全直肠系膜切除术。我们在此描述了使用这种新方法治疗直肠癌。
选择了 7 名 II 期或 III 期直肠癌患者进行该手术。通过在右髂窝处做一个 3.0cm 的切口，为腹部提供单端口通道。通过内侧入路解剖降结肠系膜，并在腹壁表面放置柱状磁铁以恢复三角关系。游离肠系膜下动脉并在淋巴结清扫过程中分离直肠上动脉。全直肠系膜切除延伸至盆底，用悬吊杆与体外磁铁工具垂直缩回直肠。然后在腹膜反射下方切断直肠。使用双吻合器技术进行腔内吻合。所有患者均通过单一切口和肛门分别插入两个盆腔引流管。没有患者行预防性回肠造口术。
中位总手术时间为 205 分钟（范围 175-245 分钟）。所有患者术中出血量均较少（范围 1-20ml）。无一例需要转为开放性手术或增加第二端口。唯一的术前或术后并发症发生在一例临床吻合口漏的患者中。
当直肠像秋千一样悬吊以确保足够的手术视野时，低位前侧单一切口腹腔镜切除术似乎是安全可行的。
