New Procedure for Laparoscopic Bowel Resection

A novel laparoscopic bowel lifting technique method could help introduce single-incision laparoscopic surgery (SILS) for low anterior resection of rectal cancer.

Developed by researchers at Yokohama City University Medical Center (Japan), the laparoscopic bowel-lifting (LBL) technique involves piercing the mesocolon near the line of transaction, using a pair of dissecting forceps. A Vicryl suture is then introduced into the abdominal cavity (using a grasping needle) and passed through the mesocolon; the colon is retracted using the suture and fixed to the abdominal wall, and traction is placed on the main nutrient artery. Mobilization of the rectum is performed by moving the traction to the cranial side using a grasping needle. As the rectal tube is pulled upwards, it becomes possible to identify the mesorectum with a good visual field.

The researchers performed the procedure in 100 consecutive patients with rectal cancer who underwent curative laparoscopic low anterior resection (Lap-LAR) between November 2001 and March 2010, with median follow-up of 53.2 months. The number of trocars used in the LBL group was 3 or 4, and no cases required 5 trocars. No operative complications were attributable to the technique. The study was published on April 14, 2014, in Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.

“Although surgeons have tried to reduce the number of ports in order to achieve better cosmesis and less postoperative pain, it may lead to increased risk for complications,” concluded lead author Keisuke Watanabe, MD, and colleagues of the gastroenterological center. “Herein, we introduce a technique which helps to reduce ports without additional trocars, and might help to introduce single-port laparoscopy surgery for bowel resection.”

SILS has been used to perform many surgical procedures, including adjustable gastric banding, appendectomy, cholecystectomy, hernia repair, hysterectomy, and others. When compared with traditional multiport laparoscopic techniques, benefits include less postoperative pain, less blood loss, faster recovery time, and better cosmetic results. Despite the potential advantages, there may also be complications, including significant postoperative pain, injury to organs, bleeding, infection, incisional hernia, intestinal adhesions, and scarring.

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Yokohama City University Medical Center