Name: clinical application of single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction
Uploaded: 2023-03-24T14:25:00
Description: Watch this Scientific Journal Video about Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction at JoVE.com

This research was supported by the Key R&#38;D Projects Medical and Health Key Technology Research and Application Program in Guangzhou, China (Project No. 202206010104).

All laparoscopic surgical procedures and postoperative treatments in this study were performed in accordance with the guidelines established by the Laparoscopic Operation Ethics Committee of the First Affiliated Hospital of Sun Yat-Sen University, China. The research protocol and content were explained to all patients, and informed consent was obtained. This study was conducted under the guidance of the ethics committee of the hospital.
1. Case inclusion criteria
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	<li>I...

<ol>
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S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Natural Orifice Specimen Extraction Surgery: Colorectal. , (2018).</li><li>Jiang, Z., Chen, Y., Wang, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+radical+resection+of+lower+rectal+cancer+through+transrectal+valgus+resection+without+abdominal+incisions.">Laparoscopic radical resection of lower rectal cancer through transrectal valgus resection without abdominal incisions.</a> Chinese Journal of Gastrointestinal Surgery. 17 (5), 499-501 (2014).</li><li>Liu, Z., Wang, G., Wang, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+median+radical+resection+for+rectal+cancer+through+the+rectum+to+pull+the+specimen+out+of+the+anus+without+abdominal+incision.">Laparoscopic median radical resection for rectal cancer through the rectum to pull the specimen out of the anus without abdominal incision.</a> Chinese Journal of Colorectal Diseases. 2 (6), 331-332 (2013).</li><li>Omori, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transumbilical+single-incision+laparoscopic+distal+gastrectomy+for+early+gastric+cancer.">Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer.</a> Surgical Endoscopy. 25 (7), 2400-2404 (2011).</li><li>Song, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reduced+port+laparoscopic+surgery+for+colon+cancer+is+safe+and+feasible+in+terms+of+short-term+outcomes:+comparative+study+with+conventional+multiport+laparoscopic+surgery.">Reduced port laparoscopic surgery for colon cancer is safe and feasible in terms of short-term outcomes: comparative study with conventional multiport laparoscopic surgery.</a> Annals of Surgical Treatment and Research. 91 (4), 195-201 (2016).</li><li>Oh, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+outcomes+of+reduced-port+laparoscopic+surgery+for+patients+with+sigmoid+colon+cancer:+surgery+with+1+surgeon+and+1+camera+operator.">Clinical outcomes of reduced-port laparoscopic surgery for patients with sigmoid colon cancer: surgery with 1 surgeon and 1 camera operator.</a> Annals of Coloproctology. 34 (6), 292-298 (2018).</li><li>Hu, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+total+mesorectal+excision+and+lateral+pelvic+lymph+node+dissection+for+locally+advanced+middle-low+rectal+cancer.">Robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced middle-low rectal cancer.</a> Journal of Visualized Experiments. (180), e62919 (2022).</li><li>Curcillo, P. G., Podolsky, E. R., King, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+road+to+reduced+port+surgery:+from+single+big+incisions+to+single+small+incisions,+and+beyond.">The road to reduced port surgery: from single big incisions to single small incisions, and beyond.</a> World Journal of Surgery. 35 (7), 1526-1531 (2011).</li><li>Inaki, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reduced+port+laparoscopic+gastrectomy+for+gastric+cancer.">Reduced port laparoscopic gastrectomy for gastric cancer.</a> Translational Gastroenterology and Hepatology. 1, 38 (2016).</li><li>Takahashi, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+multicenter+study+of+reduced+port+surgery+combined+with+transvaginal+specimen+extraction+for+colorectal+cancer+resection.">Prospective multicenter study of reduced port surgery combined with transvaginal specimen extraction for colorectal cancer resection.</a> Surgery Today. 50 (7), 734-742 (2020).</li><li>Zhou, H., Xu, K., Sun, Q., Wang, Z., Ruan, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-port+laparoscopic+sigmoidectomy+with+natural+orifice+specimen+extraction-a+video+vignette.">Three-port laparoscopic sigmoidectomy with natural orifice specimen extraction-a video vignette.</a> Colorectal Disease. 22 (11), 1782-1783 (2020).</li><li>Kim, A. C., Rist, R. C., Zureikat, A. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technical+detail+for+robot+assisted+pancreaticoduodenectomy.">Technical detail for robot assisted pancreaticoduodenectomy.</a> Journal of Visualized Experiments. (151), e60261 (2019).</li></ol>

With the improvement in surgical skills and the advancement in surgical equipment, especially the development of visualization devices, robotic surgery is often considered a reasonable choice for complex procedures, such as lateral pelvic lymph node dissection7. Reduced-port laparoscopic surgery is an emerging procedure, characterized by reduced incision number and size, making the operation less invasive than traditional laparoscopic surgery8. In 2016, Inaki<sup class='xre...

Natural orifice specimen extraction surgery (NOSES) is a modified approach to open surgery and conventional laparoscopic surgery, which relies on laparoscopic or robotic techniques. Its major advantages include a shorter length of hospital stay, reduction in wound complications and postoperative pain, faster recovery of bowel function, and better cosmetic and psychological effects. During NOSES, the surgical specimen is removed from a natural orifice (rectum or vagina) without requiring an auxiliary incision in the abdominal wall1. The &#34;Expert Consensus on NOSES for Colorectal Tumors (2019 Edition)&#34; recommends NOSES with the five-port technique2,3.
Omori et al.4 first applied reduced-port laparoscopic surgery (RPLS) to treat gastric cancer. In 2016, Kim et al. proposed that porosity reduction laparoscopic surgery was technically feasible and safe for the treatment of colorectal cancer and was comparable to conventional multiport laparoscopic surgery (CMLS) in terms of postoperative pain5. Oh et al., 2 years later, discussed the perioperative clinical outcomes of sigmoid colon cancer patients undergoing RPLS and traditional multiport laparoscopic surgery (MPLS); the results suggested that single-surgeon, three-port, laparoscopic radical sigmoidectomy was a feasible and safe surgical option for patients with favorable tumor characteristics6. However, the surgeries for sigmoid colon or high rectal cancer and specimen extraction through NOSES were mainly performed by one chief surgeon without the help of other assistants during intraoperative separation.
Currently, there are still only a few reports on NOSES. In NOSES, the placement and fixation of the anvil seat, which mainly depends on the tumor&#39;s location, the method of specimen collection, and the surgeon&#39;s ability, may be challenging. At present, a number of anvil fixation methods have been proposed, including the fixed extrusion method, reverse puncture method, snare ligation method, and manual purse-string suture method. Each method has its unique advantages and shortcomings. This study retrospectively analyzed the clinical data of 10 patients who underwent single-surgeon, three-port, laparoscopic surgery for sigmoid colon or high rectal cancer with NOSES to explore the safety and feasibility of this operation. The external anvil seat self-traction and fixation method was creatively improved, which could be used for manual purse-string suture fixation after placement of the anvil seat. Following the principle of tumor-free asepsis, the risk of anastomotic leakage and bleeding could be effectively avoided, and this surgicalprocedure could be widely promoted in primary hospitals.

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			<td>antibacterial polydioxanone</td>
			<td>Johnson &#38; Johnson</td>
			<td>8622H,SXPP1A403</td>
			<td></td>
		</tr>
		<tr>
			<td>Laparoscopic system</td>
			<td>STORZ</td>
			<td>26003BA</td>
			<td></td>
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			<td>Ring stapler</td>
			<td>Johnson &#38; Johnson</td>
			<td>CDH29A</td>
			<td></td>
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			<td>Straight cut closure</td>
			<td>Johnson &#38; Johnson</td>
			<td>EC45A</td>
			<td></td>
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		<tr>
			<td>Trocar</td>
			<td>Johnson &#38; Johnson</td>
			<td>B5LT,B11LT,B12LT</td>
			<td></td>
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clinical application of single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, laparoscopic radical resection for sigmoid colon or high rectal cancer with natural orifice specimen extraction surgery (NOSES) has the advantage of a small incision, quick postoperative recovery, and short hospital stay. Yet, there are still only a few reports on NOSES. This paper describes the indications, preoperative preparations, surgical steps, and precautions for single-surgeon, three-port, laparoscopic radical resection of the sigmoid colon and high rectal cancer, and intraoperative specimen collection through the natural orifice. 
The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

No patient had any distal ileal prophylactic stoma. Specimens from six cases were taken from the rectum, and four case specimens from the vagina. The average operation time was 169.5 &#177; 35.6 min, the average bleeding volume was 40 &#177; 13.3 mL, the average postoperative exhaust time was 43.2 &#177; 22.1 h, the average number of lymph nodes dissected was 13.1 &#177; 8.6, and the average hospital stay was 13.2 &#177; 3.6 days. No anastomotic leakage or pulmonary/abdominal infections occurred after operation. A total ...

Watch this Scientific Journal Video about Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction at JoVE.com

Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction

Here, we present a protocol to successfully perform single-surgeon, three-port, laparoscopic resection for colorectal cancer with natural orifice specimen extraction.

Reduced-port laparoscopic surgery (RPLS) has been widely used for the radical resection of gastrointestinal tumors. Single-surgeon, three-port, ...

Vår protokoll fokuserer på de tekniske punktene for reseksjon og rekonstruksjon og forbedrer prosedyren som brukes til veskestrengssuturfiksering etter at den proksimale ambolten er plating i bukhulen. Protokollen er enkel å utføre effektivt, unngår postoperativ anastomotisk lekkasje og blødning på grunn av overdreven intraoperativt anastomotisk vev. Og dette kan bli mye fremmet i primærsykehus. Visuell.Presentasjonen av denne protokollen gjør det mulig for standard å forstå hele prosedyren mer intuitivt og effektivt. For å utføre trehulls trokarinnsetting, må du først lage et 10 millimeter snitt under navlen, og sette inn en 10 millimeter trokar, deretter lage et 12 millimeter snitt over linjen som forbinder høyre navle og den fremre overlegne iliac ryggraden, og sett inn en 12 millimeter trokar i den, deretter lage et 5 millimeter snitt over høyre flate navlestreng, og sett inn en 5 millimeter trokar. Utfør en rutinemessig inspeksjon av bukhulen, undersøk deretter øvre buklever og diafragmatisk peritoneum, og kontroller bukhulen mot klokken.Probe plasseringen av svulsten og tilstøtende strukturer. For kvinnelige pasienter, bruk anastomosenåler for å suspendere livmoren til forsiden av bukveggen for å utvide det kirurgiske feltet. For å eksponere disseksjonsplanet mellom Toldt og Gerota fascia, forstørre cephalic rommet til Toldt ved å frigjøre venstre laterale side for å dissosiere sigmoid kolon og dets mesenteri, og deretter vedta mediale dissosiasjonstilnærming.Deretter løfter du mesenteriet med gastrisk tang for å eksponere det mesenteriske krysset, dissocierer det fra bunn til topp til det horisontale segmentet i tolvfingertarmen er nådd, inkludert disseksjon av lymfeknuter i 253 og 216 grupper. Etter å ha eksponert den nedre mesenteriske arterien, ligere karene for å utvide Toldt-rommet til den nedre delen av bukspyttkjertelen er nådd, og deretter ligere den nedre mesenteriske venen i høy posisjon. Utvid Toldt-rommet og trekk det underlegne mesangiumet fritt opp.Forsiktig med venstre hånd, utfør mikroekstern rotasjon av tarmtangen og trekk den proksimale tykktarmen bakover og oppover. Utsett den hypogastriske nerven mens du beskytter den under passende spenning. Etter tilstrekkelig separasjon av mesenteriet, skille mesenteriet under endetarmen for utskjæring i henhold til avstanden fra tumorstedet, noe som resulterer i en naken tarm.For å bestemme omfanget av tarmreseksjon, må du først forberede en 8 til 10 centimeter lengde silketråd in vitro og markere plasseringen av den proksimale reseksjonen av tarmrøret med silketråden på den øvre kanten av svulsten. Dissociere den proksimale tarmkanalen og avsløre den ved hjelp av en ultralyd skalpell. Bruk en endoskopisk lineær kuttstiftemaskin for å sekvensielt transektere den proksimale og distale linsen til det nakne tarmrøret.Sørg for at den distale rektalstubben skylles før prøven fjernes fra endetarmen. Snitt den distale rektale stubben og legg en ren endoskopisk gasbind under den for å forhindre forurensning av det kirurgiske feltet. Når prøven er tatt ut fra skjeden, har assistenten derogate skjeden og deretter sette inn en intestinal trykkplate.Deretter gjør du et snitt på 3 til 4 centimeter i skjeden under veiledning av tarmtrykkplaten. Gjentatte ganger, desinfiser endetarmen eller skjeden med iodoformgasbind. Sett en prøvepose inn i bukhulen gjennom den 12 millimeter trokaren som beskyttelse under prøvehenting.Plasser stiftambolten først og ta deretter ut prøven for å unngå mulig forurensning av stiftambolten. Sutur deretter vaginalveggen direkte med 3-0 antibakteriell polydioksanon. Etter at rektalstubben er suturert, løft tråden og lukk rektalstubben igjen med en endoluminal skjære- og lukkeanordning for å unngå mulighet for forurensning og anastomotisk lekkasje.For å plassere stiftesetet i den proksimale tarmen, snitt den proksimale tarmkanalen, forstørr den til et snitt på 2 til 3 centimeter og steriliser den regelmessig med iodoformgasbind. Plasser en ambolt og sutur tarmkanalen uten knuter med 3-0 polyglactin. Utfør rutinemessig ende-til-ende anastomose av tarmen gjennom anus.Sett utløserhåndtaket for ringstiftemaskinen gjennom anus. Stikk hull på senterpiercinganordningen på stiftehåndtaket, koble senterstangen til den proksimale stiftemaskinen til neglesetet, og roter tarmveggen nær de proksimale og distale endene. Trykk den anastomotiske skiftenøkkelen tett for å fullføre skjæringen og anastomosen.Deretter syr du hele omkretsen av anastomosen i et 4-0 knopfritt mønster. Skyll bukhulen og legg et dreneringsrør. Legg også et gummirør på venstre eller høyre side av bekkenet.Etter operasjonen ble det ikke observert distal ileal profylaktisk stomi hos noen pasienter. Gjennomsnittlig operasjonstid var ca. 169 minutter, og gjennomsnittlig postoperativ avtrekkstid var ca. 43 timer, med et gjennomsnittlig sykehusopphold på rundt 13 dager. Gjennomsnittlig antall dissekerte lymfeknuter var rundt 13, uten anastomoselekkasje eller lunge- eller abdominalinfeksjoner etter operasjonen.Trocarenes plassering i denne operasjonen var ekstremt viktig, da trocars plassert for nært resulterte i vanskeligheter i operasjonen. Ved hjelp av denne teknikken kunne kirurger dyktige i laparoskopiske teknikker lett dissekere lymfeknuter i anatomiske grupper 216 og 253 selv på overflaten av essensielle blodkar. Videre ble den hypogastriske nerven beskyttet under operasjonen ved å heve det proksimale tarmrøret, noe som viser at denne operasjonen er mulig for pasienter med sigmoid kolon eller endetarmskreft.Denne operasjonen forhindret også effektivt anastomoselekkasje og forbedret en in vitro ambolt selvtrekkende og fikseringsmetode. Etter operasjonen hadde pasienten kun postoperative abdominale sår på de tre hullene, noe som gjorde denne operasjonsbehandlingen minimalt invasiv. Det viktigste trinnet i protokollen er å plassere ambolten og suturere tarmkanalen.

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