title: Needlescopic surgery for left-sided colorectal cancer.
abstract: OBJECTIVE
  Laparoscopic surgery has become the standard for colorectal cancers, but more minimally invasive surgery is continuously pursued. In June 2011, our institution started needlescopic surgery (NS). The aims of this study are to describe this technique and to investigate its feasibility for left-sided colorectal cancer surgery.
  
  
  METHODS
  From June 2011 to June 2013, 105 sigmoid colon and upper/middle rectal cancer patients underwent NS in our institution, involving one 5-mm port and three 3-mm ports, with the exception of an umbilical 12-mm port. A 10-mm scope is used through the umbilical 12-mm port, which will be extended to a small skin incision for specimen extraction. After dissection of the left colon, a 5-mm scope is inserted through the right lower 5-mm port and a linear stapler is inserted through the umbilical 12-mm port for rectal transection. The specimen is then extracted through umbilical incision, and the anastomosis is carried out by the double-staple technique.
  
  
  RESULTS
  TNM staging is stage 0/I/II/III/IV = 0/31/32/31/11. Fifty-one patients underwent sigmoidectomy and 54 patients underwent anterior resection. There was no conversion to open surgery, but one patient required a change to a 5-mm port from one of the 3-mm ports. Mean operating time was 193 min and mean estimated blood loss was 12 ml. There were ten (9 %) postoperative complications: two anastomotic leaks requiring reoperation, two anastomotic hemorrhages, and one wound infection. There was no mortality.
  
  
  CONCLUSIONS
  NS for left-sided colorectal cancer was a technically and oncologically feasible technique for selected patients.
authors.affiliation: Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Mukai
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Fukunaga
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueno
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Konishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiyoshi
authors.forename: Riki
authors.initials: R
authors.lastname: Ono
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000473:pathology / Q000601:surgery*