Transumbilical laparoendoscopic single-site total mesorectal excision for rectal carcinoma

摘要

In recent years, multiple studies have proved laparoscopic total mesorectal excision (TME) to be as safe and as effective in rectal cancer treatment as open surgery, with the undeniable benefit of perioperative trauma reduction. Decreasing the number of incisions and performing single-port surgery could have further reduced the trauma. A new access device, QuadPort™ Olympus, enables operations from just one small transumbilical incision, leaving a barely visible scar afterwards. This is one of the first reports of transumbilical laparoendoscopic single-site TME for rectal carcinoma. A 73-year-old woman presented with tubulo-villous adenoma with high-grade dysplasia and focal adenocarcinoma in situ at 7 cm from the anal verge. She had TME performed via a QuadPort™, Olympus, in line with principles of laparoscopic TME. The operating time was 80 min. There were no adverse events during the procedure. Total blood loss was less than 100 ml. There were no complications in the postoperative period. The patient required only non-opioid analgesia, during the first 2 days. The patient was discharged on the 3^rd postoperative day with standard recommendations. Feasibility and safety of the proposed transumbilical laparoendoscopic single site TME for rectal carcinoma was proved. It is a technically demanding procedure, requiring appropriate laparoscopic skills. The QuadPort provided good oncological protection of the wound and easy specimen extraction. Reduced operative trauma resulted in no opioid administration in the perioperative period. Hospital stay was comparable with laparoscopic TME but the cosmetic effect was much better.