Published online Mar 21, 2018. doi: 10.3748/wjg.v24.i11.1278
Peer-review started: January 11, 2018
First decision: January 25, 2018
Revised: January 30, 2018
Accepted: February 9, 2018
Article in press: February 9, 2018
Published online: March 21, 2018
Processing time: 64 Days and 4.9 Hours
To evaluate the safety and feasibility of a new technology combining low-pressure pneumoperitoneum (LPP) and abdominal wall lift (AWL) in laparoscopic total mesorectal excision (TME) for rectal cancer.
From November 2015 to July 2017, 26 patients underwent laparoscopic TME for rectal cancer using LPP (6-8 mmHg) with subcutaneous AWL in Qilu Hospital of Shandong University, Jinan, China. Clinical data regarding patients’ demographics, intraoperative monitoring indices, operation-related indices and pathological outcomes were prospectively collected.
Laparoscopic TME was performed in 26 cases (14 anterior resection and 12 abdominoperineal resection) successfully, without conversion to open or laparoscopic surgery with standard-pressure pneumoperitoneum. Intraoperative monitoring showed stable heart rate, blood pressure and paw airway pressure. The mean operative time was 194.29 ± 41.27 min (range: 125-270 min) and 200.41 ± 20.56 min (range: 170-230 min) for anterior resection and abdominoperineal resection, respectively. The mean number of lymph nodes harvested was 16.71 ± 5.06 (range: 7-27). There was no positive circumferential or distal resection margin. No local recurrence was observed during a median follow-up period of 11.96 ± 5.55 mo (range: 5-23 mo).
LPP combined with AWL is safe and feasible for laparoscopic TME. The technique can provide satisfactory exposure of the operative field and stable operative monitoring indices.
Core tip: Low-pressure pneumoperitoneum (LPP) and abdominal wall lift (AWL) have been proposed as alternative approaches to standard-pressure pneumoperitoneum to avoid adverse cardiorespiratory effects. However, the operative field under these approaches is less optimal and accompanied by increased technical difficulties. We developed a new technique combining LPP and AWL, which improved exposure of the operative field that was compromised with LPP or AWL alone. We evaluated the safety and feasibility of this new technique in 26 cases of laparoscopic total mesorectal excision for rectal cancer. This technique can provide satisfactory exposure of the operative field and stable operative monitoring indices.