Single-incision laparoscopic-assisted surgery for colon cancer via a periumbilical approach using a surgical glove: Initial experience with 9 cases

AbstractOur initial experience of performing a single-incision laparoscopic-assisted (SILS) colectomy using a “home-made” multichannel port system is presented. Nine patients (5 women) with a median age of 67 years (range, 55–72 years) and a median body mass index of 21.2kg/m2 (range, 17.8–26.7kg/m2) underwent the SILS colectomy for colon cancer between September 2009 and March 2010. The sites of the primary tumor were the ascending colon (n=2), hepatic flexure (n=1), transverse colon (n=2), and sigmoid colon (n=4). Each trocar was introduced intraperitoneally through each finger of a surgical glove attached to the wound protector, which was applied to a midline fasciotomy made via a ¾-circular periumbilical incision. If necessary, one to three radial splits were added to the incision. The colon was mobilized intracorporeally, and the vessels were ligated intra- or extracorporeally. All the patients underwent a curative segmental colectomy without conversion to a standard multiport laparoscopy or open surgery. The median operative time and blood loss were 140min (range, 135–165min) and 50mL (range, 20–225mL), respectively. The median number of harvested lymph nodes was 18 (range, 6–31). The pathological stages included stage 0 (n=2), stage I (n=6), and stage III (n=1). The median number of postoperative analgesic use was one (range, 0–6). No intra- or postoperative complications occurred in this series. Our SILS colectomy procedure seems feasible and safe in selected patients with colon cancer

Distal gastrectomy via minilaparotomy for non-overweight patients with T1N0-1 gastric cancer: Initial experience of 30 cases

AbstractMinilaparotomy is considered to be a useful treatment alternative to laparoscopic-assisted surgery from the viewpoint of minimal invasiveness, although it has several limitations for the resection of malignant tumors. We evaluated the usefulness of distal gastrectomy via minilaparotomy for non-overweight patients with clinically diagnosed T1N0-1 gastric cancer. Clinicopathological and surgical data on 30 patients attempted to undergo distal gastrectomy via minilaparotomy (skin incision, ≤7cm) without laparoscopic assistance were analyzed. Inclusion criteria were clinically (preoperatively) diagnosed T1N0-1 gastric cancer that was not suitable for endoscopic mucosal resection located in the middle- or lower-third of the stomach and the patient body mass index ≤ 25.0 kg/m2. The minilaparotomy approach was successful in 27 patients (90%), while laparoscopic assistance was required to accomplish the procedures in three patients (10%). The type of lymph node dissection was D1 + α in 23 patients and D1 + β in 7 patients. The duration of surgery was 105–170 min (median, 143.5 min) and blood loss was 25–520 mL (median, 152.5 mL). Pathological stage was stage IA in 26 patients, IB in two patients, and stage II in two patients. Postoperative complications were wound infection in one patient, bleeding in one patient, and anastomotic ulcer in one patient. The length of postoperative stay was 7–41 (median, 11) days. With a median follow-up of 31 months, there was no recurrence. Distal gastrectomy via minilaparotomy seems feasible and safe in the majority of non-overweight patients with clinically diagnosed T1N0 gastric cancer

直腸癌前方切除後の直腸膣瘻に対して一期的閉鎖術を成し得た1例

直腸癌に対するdouble stapling technique (DST)を用いた低位前方切除術の合併症としての直腸膣瘻は比較的稀である.しかし直腸膣瘻を合併した場合,その治療に苦慮することも多い.今回,直腸膣瘻に対し経膣的閉鎖術で治癒した症例を経験したので報告する.症例は51歳,女性.子宮への直接浸潤が疑われた直腸癌に対し, DSTによる低位前方切除術,子宮全摘術を施行した.術後約2ヵ月よりときどき膣より糞便の漏出を認めるようになったため,大腸内視鏡検査を施行したところ,直腸膣瘻を認めた.瘻孔発症後6ヵ月を過ぎても軽快しないため手術目的に入院した.注腸造影検査で吻合部に一致して径約3mmの直腸膣瘻を認めた.大腸内視鏡検査では肛門縁より約5cmの直腸前壁に瘻孔開口部を認めた.手術は腰椎麻酔,載石位で施行した.左右の大陰唇,小陰唇に2-0絹糸を等間隔にかけ,その各糸の一端を大陰唇より約5cm離れた大腿皮膚にかけ,それぞれを結紮し,膣内腔を伸展した.膣内腔に径約1mmの瘻孔開口部を認めた.粘膜下にエピネフリン入り1%キシロカインを注入し,膣壁と直腸壁を解離し,膣壁を紡錐形に切除し,それに続けて瘻管を切除した.直腸壁は4-0吸収糸でGambee縫合を7針施行した.膣壁は4-0吸収糸で全層結節縫合を8針施行し,手術を終了した.摘出した瘻孔に癌の遺残は認めなかった.術後5日目より経口摂取を開始し,経過良好であった.術後約2ヵ月の大腸内視鏡検査では瘻孔部は瘢痕として認められるのみであった.術後12ヵ月後の現在も直腸膣瘻の再発は認めていない.直腸癌に対するDSTを用いた低位前方切除術の合併症としての直腸膣瘻に対し,経膣的閉鎖術を行った.本例のような小瘻孔に対してはこのような方法も有効であると考えられる.Rectovaginal fistula (RVF) is a rare disease that may occur as a stapler-related complication after a double-stapled anastomosis in a low anterior resection. We report a successfully treated case of RVF by transvaginal primary closure without fecal diversion. A 51-year-old woman developed RVF 6 months after a low anterior resection because of rectal cancer. The walls of the vagina and the rectum were separated by injecting 1% xylocaine with epinephrine into the vaginal submucosa and the fistula was excised. The rectal wall and the vaginal wall was each closed separately by interrupted sutures, which cured the disease without fecal diversion

直腸癌前方切除後の直腸膣瘻に対して一期的閉鎖術を成し得た1例

直腸癌に対するdouble stapling technique (DST)を用いた低位前方切除術の合併症としての直腸膣瘻は比較的稀である.しかし直腸膣瘻を合併した場合,その治療に苦慮することも多い.今回,直腸膣瘻に対し経膣的閉鎖術で治癒した症例を経験したので報告する.症例は51歳,女性.子宮への直接浸潤が疑われた直腸癌に対し, DSTによる低位前方切除術,子宮全摘術を施行した.術後約2ヵ月よりときどき膣より糞便の漏出を認めるようになったため,大腸内視鏡検査を施行したところ,直腸膣瘻を認めた.瘻孔発症後6ヵ月を過ぎても軽快しないため手術目的に入院した.注腸造影検査で吻合部に一致して径約3mmの直腸膣瘻を認めた.大腸内視鏡検査では肛門縁より約5cmの直腸前壁に瘻孔開口部を認めた.手術は腰椎麻酔,載石位で施行した.左右の大陰唇,小陰唇に2-0絹糸を等間隔にかけ,その各糸の一端を大陰唇より約5cm離れた大腿皮膚にかけ,それぞれを結紮し,膣内腔を伸展した.膣内腔に径約1mmの瘻孔開口部を認めた.粘膜下にエピネフリン入り1%キシロカインを注入し,膣壁と直腸壁を解離し,膣壁を紡錐形に切除し,それに続けて瘻管を切除した.直腸壁は4-0吸収糸でGambee縫合を7針施行した.膣壁は4-0吸収糸で全層結節縫合を8針施行し,手術を終了した.摘出した瘻孔に癌の遺残は認めなかった.術後5日目より経口摂取を開始し,経過良好であった.術後約2ヵ月の大腸内視鏡検査では瘻孔部は瘢痕として認められるのみであった.術後12ヵ月後の現在も直腸膣瘻の再発は認めていない.直腸癌に対するDSTを用いた低位前方切除術の合併症としての直腸膣瘻に対し,経膣的閉鎖術を行った.本例のような小瘻孔に対してはこのような方法も有効であると考えられる.Rectovaginal fistula (RVF) is a rare disease that may occur as a stapler-related complication after a double-stapled anastomosis in a low anterior resection. We report a successfully treated case of RVF by transvaginal primary closure without fecal diversion. A 51-year-old woman developed RVF 6 months after a low anterior resection because of rectal cancer. The walls of the vagina and the rectum were separated by injecting 1% xylocaine with epinephrine into the vaginal submucosa and the fistula was excised. The rectal wall and the vaginal wall was each closed separately by interrupted sutures, which cured the disease without fecal diversion