Use of a multi-instrument access device in abdominoperineal resections.
BACKGROUND
Laparoscopic colorectal surgery results in less post-operative pain, faster recovery, shorter length of stay and reduced morbidity compared with open procedures. Less or minimally invasive techniques have been developed to further minimise surgical trauma and to decrease the size and number of incisions. This study describes the safety and feasibility of using an umbilical multi-instrument access (MIA) port (Olympus TriPort+) device with the placement of just one 12-mm suprapubic trocar in laparoscopic (double-port) abdominoperineal resections (APRs) in rectal cancer patients.


METHODS
The study included 20 patients undergoing double-port APRs for rectal cancer between June 2011 and August 2013. Preoperative data were gathered in a prospective database, and post-operative data were collected retrospectively.


RESULTS
The 20 patients (30% female) had a median age of 67 years (range 46-80 years), and their median body mass index (BMI) was 26 kg/m2 (range 20-31 kg/m2). An additional third trocar was placed in 2 patients. No laparoscopic procedures were converted to an open procedure. Median operating time was 195 min (range 115-306 min). A radical resection (R0 resection) was achieved in all patients, with a median of 14 lymph nodes harvested. Median length of stay was 8 days (range 5-43 days).


CONCLUSIONS
Laparoscopic APR using a MIA trocar is a feasible and safe procedure. A MIA port might be of benefit as an extra option in the toolbox of the laparoscopic surgeon to further minimise surgical trauma.
Department of Surgery, Jeroen Bosch Medical Center, 's-Hertogenbosch, The Netherlands.
Yoen Tk
YT
van der Linden
Department of Surgery, Jeroen Bosch Medical Center, 's-Hertogenbosch, The Netherlands.
Doeke
D
Boersma
Department of Surgery, Jeroen Bosch Medical Center, 's-Hertogenbosch, The Netherlands.
Koop
K
Bosscha
Department of Surgery, Jeroen Bosch Medical Center, 's-Hertogenbosch, The Netherlands.
Daniel J
DJ
Lips
Department of Surgery, Jeroen Bosch Medical Center, 's-Hertogenbosch, The Netherlands.
Hubert A
HA
Prins