Hara Masayasu, Takayama Satoru, Sato Mikinori, Imafuji Hiroyuki, Takahashi Hiroki, Takeyama Hiromitsu
Department of Gastroenterological Surgery, Nagoya City University, Nagoya, Japan.
Surg Laparosc Endosc Percutan Tech. 2011 Oct;21(5):e235-8. doi: 10.1097/SLE.0b013e3182297667.
In laparoscopic colon resection for rectosigmoid colon cancer, minilaparotomy is usually necessary for specimen retrieval and completion of primary anastomosis. This incision may increase postoperative pain, and cause wound infection or other complications. We describe a new technique of laparoscopic anterior colon resection without requiring a minilaparotomy incision.
We attempted this procedure on 9 patients with sigmoid colon or rectal cancer. We ligated the inferior mesenteric artery and divided the bowel proximally, similar to conventional laparoscopic technique. We pulled out the specimen and the rectum transanally, and performed distal colon division extracorporeally. An anvil was inserted transanally into corporeal cavity and then, inserted into the proximal stump of the colon lumen laparoscopically. We placed a purse-string suture extracorporeally around the distal colon stump, and then completed a side-to-end anastomosis intracorporeally.
The procedure was successfully completed in 8 of the 9 patients. Median operative time was 293 minutes and median blood loss was 47.2 mL. No major complications were observed.
This novel technique of transanal specimen retrieval and intracorporeal anastomosis with extracorporeal purse-string placement can be performed safely and easily in patients with rectosigmoid colon cancer.
在腹腔镜乙状结肠直肠癌切除术中，通常需要做小切口剖腹术来取出标本并完成一期吻合。该切口可能会增加术后疼痛，并导致伤口感染或其他并发症。我们描述一种无需小切口剖腹术的腹腔镜前位结肠切除术新技术。
我们对9例乙状结肠癌或直肠癌患者尝试了该手术。我们结扎肠系膜下动脉并在近端离断肠管，这与传统腹腔镜技术类似。我们经肛门拉出标本和直肠，并在体外离断远端结肠。经肛门将吻合器抵钉座插入体腔，然后经腹腔镜插入结肠腔近端残端。我们在体外结肠远端残端周围放置荷包缝线，然后在体内完成端侧吻合。
9例患者中有8例成功完成手术。中位手术时间为293分钟，中位失血量为47.2毫升。未观察到严重并发症。
这种经肛门取出标本并在体外放置荷包缝线后进行体内吻合的新技术，可在乙状结肠直肠癌患者中安全、轻松地实施。
