Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2018; 24(11): 1278-1284
Published online Mar 21, 2018. doi: 10.3748/wjg.v24.i11.1278
Low-pressure pneumoperitoneum with abdominal wall lift in laparoscopic total mesorectal excision for rectal cancer: Initial experience
Ping-Tian Xia, Maimaiti Yusofu, Hai-Feng Han, Chun-Xiao Hu, San-Yuan Hu, Wen-Bin Yu, Shao-Zhuang Liu
Ping-Tian Xia, Maimaiti Yusofu, Hai-Feng Han, Chun-Xiao Hu, San-Yuan Hu, Wen-Bin Yu, Shao-Zhuang Liu, Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
Author contributions: Xia PT, Hu SY, Yu WB and Liu SZ designed the study, analyzed the data and wrote the paper; Yusofu M, Yu WB and Liu SZ performed the surgery and treated the patients; Han HF and Hu CX collected and analyzed the patient data; Hu SY and Liu SZ approved the final manuscript.
Supported by the Special Found for Taishan Scholar Project of Shandong Province, China.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Scientific Research of Shandong University Qilu Hospital.
Informed consent statement: In this study, all involved participants or their legal guardian provided informed written consent before surgery.
Conflict-of-interest statement: No authors of this paper have conflicting interests.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The guidelines of the CONSORT 2010 Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shao-Zhuang Liu, MD, PhD, Attending Doctor, Postdoc, Department of General Surgery, Qilu Hospital of Shandong University, 107#, Wenhua Xi Road, Jinan 250012, Shandong Province, China. liushaozhuang@sdu.edu.cn
Telephone: +86-531-86920598 Fax: +86-531-86920598
Received: January 11, 2018
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
Abstract
AIM

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Laparoscopic surgery, Abdominal wall lift, Low-pressure pneumoperitoneum, Rectal cancer, Total mesorectal excision

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.