Abstract
Background
Current transperitoneal approaches to colorectal resections can be technically challenging, especially in obese patients. The head-down position can lead to rare but serious complications, e.g. compartment syndrome and brachial plexus injuries.
Objective
The aim of this study was to assess the safety and feasibility of a novel extraperitoneal approach in patients requiring anterior resection.
Methods
The extraperitoneal left-sided approach was performed in the supine position. A 5 cm LIF incision was created into which a Gelpoint port was inserted. The full video of the procedure is embedded in the QR code below. The procedure was performed by three surgeons with experience in minimally invasive surgery. Patients requiring left colonic resections were prospectively selected over a 2-year period.
Results
Forty-one patients were prospectively assessed between March 2020 and April 2022; 26 were males, with a median age of 67 (55–88) years. The average body mass index (BMI) was 30 (22–40). 38/41 cases were cancers and three were diverticular diseases; 31 cases had anterior resection and 11 had sigmoid colectomies. Peak airway pressures were significantly less (10 cmH20) in the supine position compared with the head-down position (p < 0.0001). Median time to identify the ureter and gonadal vessels was 23 (3–55) min, and median time to return of bowel function and length of stay was 2 (0–13) and 5 (IQR 3–7) days, respectively. No intraoperative complications or postoperative mortality occurred within 90 days of discharge. Three patients had anastomotic complications, and an R0 resection was achieved in all 38 cancer patients. The median lymph node count was 16.
Conclusion
Extraperitoneal surgery for left colonic resections is safe and clinically feasible, and allows for early identification of important retroperitoneal structures.
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Contributions
Tarek S. Hany was responsible for the design of the study, study dataset, performing the operative technique, and editing the paper. Alka M. Jadav contributed to the surgical technique, and editing and narrating the voiceover for the video. Arnab K. Bhowmick is the senior author and contributed to the surgery and overall editing of the manuscript. Catherine Lamoon is a senior photographer who was responsible for editing the video. Kelly Cassidy is a Medical Artist who was responsible for the diagrams and three-dimensional drawings.
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Tarek S. Hany, Alka M. Jadav, Arnab K. Bhowmick, Catherine Lamoon, and Kelly Cassidy confirm they have no commercial or financial support or conflicts of interest in relation to the subject matter of this study.
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Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
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Hany, T.S., Jadav, A.M., Lamoon, C. et al. The Extraperitoneal Approach to Left-Sided Colorectal Rectal Resections: EXPERTS Procedure. Ann Surg Oncol 30, 1739–1740 (2023). https://doi.org/10.1245/s10434-022-12848-8
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DOI: https://doi.org/10.1245/s10434-022-12848-8