A Y-shaped vinyl hood that creates pneumoperitoneum in laparoscopic rectal cancer surgery (Y-hood method.): a new technique for laparoscopic low anterior resection.
BACKGROUND
Many studies have focused on laparoscopic techniques for the treatment of colon cancer, but such work is more limited for the treatment of rectal cancer, largely because of concerns for safety issues. This report presents an effective method of anal lavage and excision in laparoscopic low anterior resection.


METHODS
The authors developed clamp forceps for intestinal lavage and a Y-shaped vinyl hood that can be operated under pneumoperitoneum for airproof surgery. These devices enabled secure clamping and cleansing of the area and use of automatic suture instruments for open laparotomy through a minilaparotomy wound. The authors called this technique the Y-Hood method and compared its short-term results from May 2005 to October 2008 (n = 28) with those for double-stapling technique surgical cases between September 2000 and October 2008 in which automatic suture instruments were used more than once (n = 107). A multivariate analysis of risk factors for anastomotic leakage also was performed.


RESULTS
No difference in background factors such as patient sex, age, and tumor node metastasis (TNM) staging were detected. Anastomotic leakage was found in 12 cases that used multiple stapling for rectal transection (11.2%) and 2 cases that used the Y-Hood (7.1%). The cost for rectectomy was 92,505 yen for multiple stapling and 53,107 yen for the Y-Hood (p < 0.0001). As risk factors for anastomotic leakage, multivariate analysis identified the number of times stapling for rectal transection was performed and the height of the anastomotic region.


CONCLUSIONS
The Y-Hood method enables operations to be performed within the interior of the pelvis without reducing the number of ports because the instruments can be accessed using minilaparotomy. Because the use of stapling for rectal transection is minimized, this method is effective in avoiding anastomotic leakage and also cost efficient. The Y-Hood method allows for thorough intestinal lavage and safe laparoscopic low anterior resection.
Fujii
Shoichi
S
Department of Surgery, Gastroenterological Center, Yokohama City University, Minami-ku, Yokohama, Japan. u0970047@urahp.yokohama-cu.ac.jp
Ota
Mitsuyoshi
M
Yamagishi
Shigeru
S
Kunisaki
Chikara
C
Osada
Shunichi
S
Suwa
Hirokazu
H
Ichikawa
Yasushi
Y
Shimada
Hiroshi
H
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D004867:Equipment Design; D017743:Equipment Reuse / Q000191:economics; D005260:Female; D006801:Humans; D007564:Japan; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000191:economics / Q000295:instrumentation*; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000601:surgery*; D013525:Surgical Instruments; D017792:Surgical Stapling / Q000191:economics; D013536:Suture Techniques / Q000191:economics / Q000295:instrumentation; D007507:Therapeutic Irrigation