結腸癌内視鏡的切除後の単孔式結腸切除術

抄録

We report our initial experience of single-incision laparoscopy-assisted (SILS) colectomy in patients who underwent segmental colectomy for colon tumor as an additional procedure after colonoscopic treatment. The key points of our SILS colectomy are (1) placing a 3/4-circumferential peruimbilical skin incision with multiple radial splits if necessary, and (2) using a multiport channel system with a surgical glove. There were 3 men and 2 women, with a median age of 68 (range : 59-72) years. The median patients′body mass index was 21.9 (range : 19.1-22.8) kg/m². The reasons for additional colectomy included non-lifting sign in two patients, endoscopically unresectable lesion in one patient, positive resective margin in one patient, and massive invasion to the submucosa in two patients with positive vertical margin in one patient. The location of tumor was transverse colon in three patients and sigmoid colon in two patients. Segmental colectomy with D2-lymph node dissection was successfully performed in all patients. The median operative time was 155 (range : 135-230) minutes and median blood loss was 60 (range : 20-90) mL. Pathological examination revealed adenoma with severe atypia in one patient, pTNM stageI adenocarcinoma in the remaining 4 patients. Wound infection occurred in one patient. At the median follow-up period of 13.3 (range : 6.1-15.2) months, there have been no recurrence or late wound complications. Therese results suggest that our SILS colectomy seems feasible, safe, and could be a minimally invasive alternative in selective patients with colon tumor.