title: Single-incision Plus One Port Laparoscopic Total Mesorectal Excision and Bilateral Pelvic Node Dissection for Advanced Rectal Cancer--A Medial Umbilical Ligament Approach.
abstract: We prove the safety and feasibility of single-incision plus 1 port (SILS+1) laparoscopic total mesorectal excision (TME) + lateral pelvic lymph node dissection (LPLD) via a medial umbilical approach for rectal cancer. Only a few reports have been published about single-incision multiport laparoscopic low anterior resection with LPLD. Recently, minimally invasive surgery such as single-incision plus 1 port (SILS + 1) for advanced rectal cancer has been reported as safe and feasible. To our knowledge, this is the first reported case of SILS + 1 used for LPLD. A wound protector was inserted through a 30-mm transumbilical incision. Next, a single-port access device was mounted to the wound protector and 3 ports (5 mm each) were placed. A 12-mm port was inserted in the right lower quadrant. Super-low anterior resection of the rectum and bilateral LPLD and temporary ileostomy were performed with SILS + 1, with a blood loss of 50 mL and a total surgical time of 525 minutes. The time for right lateral dissection was 74 minutes; the time for left lateral dissection was 118 minutes. The total number of dissected lymph nodes was 57 and the number of lateral lymph nodes dissected was 21 (8 left pelvic lymph nodes, 13 right pelvic lymph nodes). No postoperative anastomotic insufficiency or voiding dysfunction was observed. We have documented the safety and feasibility of SILS + 1-TME + LPLD via a medial umbilical approach for rectal cancer.
authors.affiliation: Department of Surgery, Yao Municipal Hospital, Osaka, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Tokuoka
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ide
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Takeda
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Jin
authors.initials: J
authors.lastname: Matsuyama
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yukio
authors.initials: Y
authors.lastname: Fukushima
authors.forename: Takashi
authors.initials: T
authors.lastname: Nomura
authors.forename: Ken
authors.initials: K
authors.lastname: Kodama
authors.forename: Yo
authors.initials: Y
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008022:Ligaments / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D010388:Pelvis; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D014472:Umbilicus / Q000601:surgery
keywords: Laparoscopic low anterior resection; Lateral pelvic node dissection; Reduced port surgery; Single-incision laparoscopic surgery