Endo Shungo, Takehara Yusuke, Tanaka Jun-Ichi, Hidaka Eiji, Mukai Shumpei, Omoto Tomokatsu, Ishida Fumio, Kudo Shin-Ei
Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Asian J Endosc Surg. 2013 Nov;6(4):338-41. doi: 10.1111/ases.12045.
Laparoscopic-assisted colorectal surgery requires a mini-laparotomy to extract the specimen and insert the anvil head of the circular stapler into the proximal colon. However, such a mini-laparotomy occasionally causes local pain and surgical-site infection. To avoid mini-laparotomy, we invented a new laparoscopic technique, complete laparoscopic surgery for colorectal cancer.
Sigmoid colon or rectal cancer patients who had undergone colonoscopic excision for T1 cancer and subsequently required bowel resection due to unfavorable histology were recruited. This new procedure used both the double stapling technique and the rectal-prolapsing technique, where the anvil was transanally inserted into the proximal colon and bowel resection was extracorporeally performed after pulling out the colon-rectum via the anus.
This procedure was attempted in 17 patients and successfully achieved in 13 patients. Total laparoscopic colorectal surgery has some problems such as bacterial contamination or infection, as well as dissemination caused by intraluminal exfoliated cancer cells. This procedure is limited to post-endoscopic resection patients who are suited for reconstruction by double stapling technique, and it may be impossible in patients with thick mesentery or anal stenosis. Moreover, this method resolves issues of peritoneal contamination and dissemination. However, a new protection method for implantation of exfoliated cancer cells needs to be established, so that complete laparoscopic surgery can be employed in patients with small cancers.
腹腔镜辅助结直肠手术需要做一个小剖腹术来取出标本并将圆形吻合器的砧头插入近端结肠。然而，这样的小剖腹术偶尔会引起局部疼痛和手术部位感染。为避免小剖腹术，我们发明了一种新的腹腔镜技术，即结直肠癌全腹腔镜手术。
招募因T1期癌接受结肠镜切除且随后因组织学不良需要肠切除的乙状结肠癌或直肠癌患者。这种新手术使用了双吻合技术和直肠脱垂技术，即通过肛门将砧头经肛门插入近端结肠，经肛门拉出结肠直肠后在体外进行肠切除。
该手术在17例患者中尝试，13例成功完成。全腹腔镜结直肠手术存在一些问题，如细菌污染或感染，以及腔内脱落癌细胞导致的播散。该手术仅限于适合双吻合技术重建的内镜切除术后患者，对于肠系膜肥厚或肛门狭窄的患者可能无法实施。此外，该方法解决了腹膜污染和播散问题。然而，需要建立一种新的脱落癌细胞种植保护方法，以便在小癌患者中应用全腹腔镜手术。
