Advertisement

Surgical Endoscopy

, Volume 34, Issue 2, pp 752–757 | Cite as

Feasibility of needlescopic surgery for colorectal cancer: safety and learning curve for Japanese Endoscopic Surgical Skill Qualification System-unqualified young surgeons

  • Hisanori Miki
  • Yosuke FukunagaEmail author
  • Toshiya Nagasaki
  • Takashi Akiyoshi
  • Tsuyoshi Konishi
  • Yoshiya Fujimoto
  • Satoshi Nagayama
  • Masashi Ueno
Article
  • 150 Downloads

Abstract

Background

Needlescopic surgery (NS) is a minimally invasive technique for colorectal cancer. NS may be easier to perform than other minimally invasive surgery such as single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery because the port setting is the same while the shafts are thinner than in conventional laparoscopic surgery. We evaluated the capability of introducing this surgery for sigmoid and rectosigmoid colon cancer by assessing the learning curve in Japanese Endoscopic Surgical Skill Qualification System (JESSQS)-unqualified surgeons.

Methods

In this retrospective study, 112 cases of sigmoidectomy and anterior resection were performed by NS from October 2011 to December 2015 in our institution. Surgical outcomes including operation time, blood loss, postoperative hospital stay, perioperative complications, and overall survival were compared between JESSQS-qualified surgeons (Group A) and JESSQS-unqualified surgeons (Group B). The learning curve for NS was established using the average operation times in JESSQS-unqualified surgeons.

Results

Groups A and B comprised of 41 and 71 patients, respectively. Ninety patients underwent sigmoidectomy and 22 patients underwent anterior resection. No conversion to open surgery occurred. The operation time was significantly shorter in Group A than B (P = 0.0080). There were no significant differences in blood loss, the postoperative hospital stay, perioperative complications, or overall survival between the two groups. These variables were similar even when NS was considered relatively difficult, as in patients with obesity (body mass index of ≥ 25 kg/m2), bulky tumors (tumor size of ≥ 50 mm), and stage III/IV cancer. The average operation time in JESSQS-unqualified young surgeons was significantly shorter in the ninth and tenth cases than in the first and second cases of NS (P = 0.0282).

Conclusions

NS for sigmoid and rectosigmoid colon cancer was performed safely by both JESSQS-qualified surgeons and JESSQS-unqualified surgeons. Even JESSQS-unqualified young surgeons might be able to quickly learn NS techniques.

Keywords

Needlescopic surgery Colorectal cancer Learning curve Novice surgeon Feasibility and Safety Endoscopic surgical skill qualification system 

Notes

Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac), for editing a draft of this manuscript.

Funding

This research did not receive any specific grant funding from agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Disclosures

Drs. Hisanori Miki, Yosuke Fukunaga, Toshiya Nagasaki, Takashi Akiyoshi, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, and Masashi Ueno have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  2. 2.
    Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, Guillou PJ, Thorpe H, Brown J, Delgado S, Kuhrij E, Haglind E, Pahlman L (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303CrossRefGoogle Scholar
  3. 3.
    Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG, Brown JM (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82CrossRefGoogle Scholar
  4. 4.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefGoogle Scholar
  5. 5.
    Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645CrossRefGoogle Scholar
  6. 6.
    Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRefGoogle Scholar
  7. 7.
    Lujan HJ, Plasencia G, Jacobs M, Viamonte M 3rd, Hartmann RF (2002) Long-term survival after laparoscopic colon resection for cancer: complete five-year follow-up. Dis Colon Rectum 45:491–501CrossRefGoogle Scholar
  8. 8.
    Takahashi R, Sakamoto K, Ro H, Kure K, Kawai M, Ishiyama S, Sugimoto K, Kojima Y, Okuzawa A, Tomiki Y (2018) A case of total laparoscopic sigmoidectomy involving the use of needle forceps and transanal specimen extraction for sigmoid colon cancer. J Minim Access Surg 14:71–73CrossRefGoogle Scholar
  9. 9.
    Sakamoto K, Okazawa Y, Takahashi R, Sugimoto K, Komiyama H, Takahashi M, Kojima Y, Goto M, Okuzawa A, Tomiki Y (2014) Laparoscopic intersphincteric resection using needlescopic instruments. J Minim Access Surg 10:221–224CrossRefGoogle Scholar
  10. 10.
    Mukai T, Fukunaga Y, Ueno M, Nagayama S, Fujimoto Y, Konishi T, Akiyoshi T, Ono R, Yamaguchi T (2014) Needlescopic surgery for left-sided colorectal cancer. Int J Colorectal Dis 29:1501–1505CrossRefGoogle Scholar
  11. 11.
    Santoro E, Agresta F, Veltri S, Mulieri G, Bedin N, Mulieri M (2008) Minilaparoscopic colorectal resection: a preliminary experience and an outcomes comparison with classical laparoscopic colon procedures. Surg Endosc 22:1248–1254CrossRefGoogle Scholar
  12. 12.
    Bona S, Molteni M, Montorsi M (2012) Minilaparoscopic colorectal resections: technical note. Minim Invasive Surg.  https://doi.org/10.1155/2012/482079 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Alhashemi M, Almahroos M, Fiore JF Jr, Kaneva P, Gutierrez JM, Neville A, Vassiliou MC, Fried GM, Feldman LS (2017) Impact of miniport laparoscopic cholecystectomy versus standard port laparoscopic cholecystectomy on recovery of physical activity: a randomized trial. Surg Endosc 31:2299–2309CrossRefGoogle Scholar
  14. 14.
    Gagner M, Garcia-Ruiz A (1998) Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc 8:171–179CrossRefGoogle Scholar
  15. 15.
    Kimura T, Mori T, Konishi F, Kitajima F (2010) Endoscopic surgical skill qualification system in Japan: five years of experience in the gastrointestinal field. Asian J Endosc Surg 3:66–70CrossRefGoogle Scholar
  16. 16.
    Yamakawa T, Kitajima T, Matsuda T, Konishi F, Bandai Y (2013) Endoscopic Surgical Skill Qualification System (ESSQS) of the Japanese Society of Endoscopic Surgery (JSES). BH Surg 3:6–8Google Scholar
  17. 17.
    Mori T, Kimura T, Kitajima M (2010) Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol 19:18–23CrossRefGoogle Scholar
  18. 18.
    Tanigawa N, Lee SW, Kimura T, Mori T, Uyama I, Nomura E, Okuda J, Konishi F (2011) The Endoscopic Surgical Skill Qualification System for gastric surgery in Japan. Asian J Endosc Surg 4:112–115CrossRefGoogle Scholar
  19. 19.
    Habuchi T, Terachi T, Mimata H, Kondo Y, Kanayama H, Ichikawa T, Nutahara K, Miki T, Ono Y, Baba S, Naito S, Matsuda T (2012) Evaluation of 2,590 urological laparoscopic surgeries undertaken by urological surgeons accredited by an endoscopic surgical skill qualification system in urological laparoscopy in Japan. Surg Endosc 26:1656–1663CrossRefGoogle Scholar
  20. 20.
    Feinberg EJ, Agaba E, Feinberg ML, Camacho D, Vemulapalli P (2012) Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution. Surg Laparosc Endosc Percutan Tech 22:114–117CrossRefGoogle Scholar
  21. 21.
    Han HJ, Choi SB, Park MS, Lee JS, Kim WB, Song TJ, Choi SY (2011) Learning curve of single port laparoscopic cholecystectomy determined using the non-linear ordinary least squares method based on a non-linear regression model: an analysis of 150 consecutive patients. J Hepatobiliary Pancreat Sci 18:510–515CrossRefGoogle Scholar
  22. 22.
    Qiu Z, Sun J, Pu Y, Jiang T, Cao J, Wu W (2011) Learning curve of transumbilical single incision laparoscopic cholecystectomy (SILS): a preliminary study of 80 selected patients with benign gallbladder diseases. World J Surg 35:2092–2101CrossRefGoogle Scholar
  23. 23.
    Solomon D, Bell RL, Duffy AJ, Roberts KE (2010) Single-port cholecystectomy: small scar, short learning curve. Surg Endosc 24:2954–2957CrossRefGoogle Scholar
  24. 24.
    Kravetz AJ, Iddings D, Basson MD, Kia MA (2009) The learning curve with single-port cholecystectomy. JSLS 13:332–336PubMedPubMedCentralGoogle Scholar
  25. 25.
    Vestweber B, Galetin T, Lammerting K, Paul C, Giehl J, Straub E, Kaldowski B, Alfes A, Vestweber KH (2013) Single-incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS. Surg Endosc 27:434–442CrossRefGoogle Scholar
  26. 26.
    Fung AK, Aly EH (2012) Systematic review of single-incision laparoscopic colonic surgery. Br J Surg 99:1353–1364CrossRefGoogle Scholar
  27. 27.
    Wakasugi M, Tanemura M, Tei M, Furukawa K, Suzuki Y, Masuzawa T, Kishi K, Akamatsu H (2017) Safety and feasibility of single-incision laparoscopic cholecystectomy in obese patients. Ann Med Surg 13:34–37CrossRefGoogle Scholar
  28. 28.
    Zhou YM, Wu LP, Zhao YF, Xu DH, Li B (2012) Single-incision versus conventional laparoscopy for colorectal disease: a meta-analysis. Dig Dis Sci 57:2103–2112CrossRefGoogle Scholar
  29. 29.
    Shibao K, Matayoshi N, Sato N, Higure A (2015) Reduced port distal gastrectomy with a multichannel port plus one puncture (POP). Surg Technol Int 26:92–99PubMedGoogle Scholar
  30. 30.
    Keller DS, Flores-Gonzalez JR, Sandhu J, Ibarra S, Madhoun N, Haas EM (2015) SILS v SILS + 1: a case-matched comparison for colorectal surgery. J Gastrointest Surg 19:1875–1879CrossRefGoogle Scholar
  31. 31.
    Kim SJ, Kim KH, An CH, Kim JS (2015) Innovative technique of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration: a comparative study. World J Gastroenterol 21:12857–12864CrossRefGoogle Scholar
  32. 32.
    Kim TS, Kim KH, An CH, Kim JS (2016) Single center experiences of needle-scopic grasper assisted single incision laparoscopic cholecystectomy for gallbladder benign disease: comparison with conventional 3-port laparoscopic cholecystectomy. Ann Surg Treat Res 91:233–238CrossRefGoogle Scholar
  33. 33.
    Rieder E, Swanstrom LL (2011) Advances in cancer surgery: natural orifice surgery (NOTES) for oncological diseases. Surg Oncol 20:211–218CrossRefGoogle Scholar
  34. 34.
    Ichikawa N, Homma S, Yoshida T, Ohno Y, Kawamura H, Kamiizumi Y, Iijima H, Taketomi A (2018) Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. Surg Endosc 32:436–442CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hisanori Miki
    • 1
  • Yosuke Fukunaga
    • 1
    Email author
  • Toshiya Nagasaki
    • 1
  • Takashi Akiyoshi
    • 1
  • Tsuyoshi Konishi
    • 1
  • Yoshiya Fujimoto
    • 1
  • Satoshi Nagayama
    • 1
  • Masashi Ueno
    • 1
  1. 1.Department of Gastroenterological SurgeryCancer Institute Hospital of the Japanese Foundation for Cancer ResearchTokyoJapan

Personalised recommendations