The Improvement of Gynecological Gasless Laparoscopic Surgery Using a Subcutaneous Abdominal Wall Lifting Method

Background: To evaluate the usefulness of gasless laparoscopic surgery using a Subcutaneous Abdominal Wall Lifting method (SAWL) for gynecological tumors. Methods: 5309 patients underwent gasless surgery with SAWL in our hospital between April 1993 and December 2015. Patient background as well as the number of annual cases, operation time, estimated blood loss, number of ports, blood transfusion, and shift to laparotomy were examined. With regards to Laparoscopic Cystectomy (LC), Laparoscopic Myomectomy (LM) and Laparoscopic Tubectomy (LT), we divided their cases into two stages-the first stage (FS) that we performed surgery with double-operated ports (1993-2005), and the second stage (SS) after a single-operated port surgery introduction (2008-2015) for comparison. Results: LC was the most frequently performed (2068 patients), followed by LM (1738 patients) and LT (510 patients). A single-operated port laparoscopic surgery, which we called a Gasless Reduced Port Surgery (GRPS), was introduced in 2005, and by 2008 it had accounted for almost 90% of gasless laparoscopic surgeries overall except for total laparoscopic hysterectomy. The mean operation time was significantly shorter in SS than FS for LC and LT, and it was no significant difference between two stages for LM. The estimated blood loss significantly decreased in SS compared to FS for LM and LT, and no significant difference for LC. The conversion rate in SS was 0.07%. Conclusion: GRPS is an operative procedure that is superior to the rate of conversion to laparotomy and is aesthetically superior in addition to having advantages of the conventional gasless method.

Compliance with D2 lymph node dissection in reduced-port totally laparoscopic distal gastrectomy in patients with gastric cancer

This phase II clinical trial was performed to determine whether reduced-port laparoscopic surgery with complete D2 lymph node (LN) dissection for gastric cancer is a safe and feasible surgical technique. The prospectively enrolled 65 gastric cancer patients underwent reduced-port surgery (i.e., triple-incision totally laparoscopic distal gastrectomy [Duet TLDG] with D2 lymphadenectomy). Compliance rate was the primary outcome, which was defined as cases in which there was no more than one missing LN station during D2 LN dissection. The secondary outcomes were the numbers of dissected and retrieved LNs in each station and other short-term surgical outcomes and postoperative course. The compliance rate was 58.5%. The total number of retrieved LNs was 41 (range: 14–83 LNs). The most common station missing from LN retrieval was station no. 5 (35/65; 53.8%), followed by station no. 1 (24/65; 36.9%). The overall postoperative complication rate was 20.0% (13/65). One patient underwent surgical treatment for postoperative complications. There was no instances of mortality. Duet TLDG is an oncologically and technically safe surgical method of gastrectomy and D2 lymphadenectomy.

Reduced-port totally robotic distal subtotal gastrectomy for gastric cancer: 100 consecutive cases in comparison with conventional robotic and laparoscopic distal subtotal gastrectomy

By overcoming technical difficulties with limited access faced when performing reduced-port surgery for gastric cancer, reduced-port totally robotic gastrectomy (RPRDG) could be a safe alternative to conventional minimally invasive gastrectomy. An initial 100 consecutive cases of RPRDG for gastric cancer were performed from February 2016 to September 2018. Short-term outcomes for RPRDG with those for 261 conventional laparoscopic (CLDG) and for 241 robotic procedures (CRDG) over the same period were compared. Learning curve analysis for RPRDG was conducted to determine whether this procedure could be readily performed despite fewer access. During the first 100 cases of RPRDG, no surgeries were converted to open or laparoscopic surgery, and no additional ports were required. RPRDG showed longer operation time than CLDG (188.4 min vs. 166.2 min, p < 0.001) and similar operation time with CRDG (183.1 min, p = 0.315). The blood loss was 35.4 ml for RPRDG, 85.2 ml for CLDG (p < 0.001), and 41.2 ml for CRDG (p = 0.33). The numbers of retrieved lymph nodes were 50.5 for RPRDG, 43.9 for CLDG (p = 0.003), and 55.0 for CRDG (p = 0.055). Postoperative maximum C-reactive protein levels were 96.8 mg/L for RPRDG, 87.8 mg/L for CLDG (p = 0.454), and 81.9 mg/L for CRDG (p = 0.027). Learning curve analysis indicated that the overall operation time of RPRDG stabilized at 180 min after 21 cases. The incidence of major postoperative complications did not differ among groups. RPRDG for gastric cancer is a feasible and safe alternative to conventional minimally invasive surgery. Notwithstanding, this procedure failed to reduce postoperative inflammatory responses.

Feasibility of Single-Incision Clipless Laparoscopic Total Colectomy for intractable slow transit constipation

Background: In 2014, we reported single-incision clipless laparoscopic total colectomy (SCLTC) with ileorectal anastomosis (IRA) as a type of reduced-port surgery for several benign diseases. Patients with intractable slow transit constipation (STC) have undergone SCLTC with IRA since it was introduced in our institution. However, the feasibility and usefulness of the surgical procedure for patients with intractable STC has not been elucidated.Methods: From January 2011 to December 2018, twenty-two patients with intractable STC underwent SCLTC with IRA at Kashiwa Hospital, Jikei University, were retrospectively registered in this study. We compared the first 12 consecutive patients undergoing the double stapling technique (DST) with IRA (DST group) with the last 10 consecutive patients undergoing functional end-to-end anastomosis (FEEA) with IRA (FEEA group).Results: The mean surgical time was 200.2 (150-249) min for the FEEA group and 230.7 (180-266) min for the DST group. A significant difference was identified between the two groups (0.035). There were no significant differences between the groups with respect to the mean age, sex, constipation type, intraoperative blood loss, or postoperative hospital stay. No postoperative complications were encountered in either group.Conclusion: Although SCLTC cannot be easily introduced for intractable STC, SCLTC with IRA using FEEA is feasible and safe.