Efficacy of surgical measures in preventing port-site recurrences in a porcine model
- C. SchneiderAffiliated withDepartment of Surgery and Pathology, University of Erlangen
- , A. JungAffiliated withDepartment of Surgery and Pathology, University of Erlangen
- , M. A. ReymondAffiliated withDepartment of Surgery, University of Geneva
- , A. TannapfelAffiliated withInstitute of Pathology, University of Leipzig
- , J. BalliAffiliated withTexas Endosurgery Institute
- , M. E. FranklinAffiliated withTexas Endosurgery Institute
- , W. HohenbergerAffiliated withDepartment of Surgery and Pathology, University of Erlangen
- , F. KöckerlingAffiliated withDepartment of Surgery and Pathology, University of Erlangen
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Port-site recurrences are serious complications of laparoscopy performed for cancer. Incidences reported in the literature vary between 0% and 21%, suggesting an influence of the surgeon.
The aim of this experimental, prospective, randomized, single-blind study was to investigate the influence that the quality surgery has on the incidence of port-site recurrences. After a 12-mmHg carbon dioxide (CO2) pneumoperitoneum was created, 107 human HeLa cell were injected into the peritoneal cavity of 18 pigs, creating a xenogeneic tumor. Laparoscopic sigmoid resections then were performed using four trocars and a transanal double-stapling technique. The following protective measures were applied in nine animals: trocar fixation, prevention of gas leaks, rinsing of instruments with povidone-iodine, minilaparotomy protection, rinsing of trocars before removal, peritoneal closure, and rinsing of all wounds with povidoneiodine. Surgeons and type of procedures were randomized. After 4 weeks, the animals were killed and all portsites excised. Blinded immunohistologic analysis with antihuman pancytokeratin antibody was performed.
Tumor recurrence was present in 23 of 36 port sites (63.8%) in the control group, but only in 5 of 36 port sites (13.8%) in the group that received protective measures (p=0.002; Fisher’s exact test). No peritoneal carcinosis nor anastomotic recurrences were observed.
These results strongly suggest that the quality of surgical technique has an influence on the incidence of port-site recurrences. From now on, we propose to use these protective measures reoutinely in cancer laparoscopy.
Key wordsCancer laparoscopy Laparoscopy side effects Port-site recurrences Prevention
- Efficacy of surgical measures in preventing port-site recurrences in a porcine model
Volume 15, Issue 2 , pp 121-125
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- Cancer laparoscopy
- Laparoscopy side effects
- Port-site recurrences
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- Author Affiliations
- 1. Department of Surgery and Pathology, University of Erlangen, Germany
- 2. Department of Surgery, University of Geneva, Switzerland
- 3. Institute of Pathology, University of Leipzig, Germany
- 4. Texas Endosurgery Institute, San Antonio, TX, USA