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Efficacy of surgical measures in preventing port-site recurrences in a porcine model

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Surgery and Pathology, University of Erlangen, Germany

    C. Schneider, A. Jung, W. Hohenberger & F. Köckerling

  2. Department of Surgery, University of Geneva, Switzerland

    M. A. Reymond

  3. Institute of Pathology, University of Leipzig, Germany

    A. Tannapfel

  4. Texas Endosurgery Institute, San Antonio, TX, USA

    J. Balli & M. E. Franklin

Authors
  1. C. Schneider
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  2. A. Jung
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  3. M. A. Reymond
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  4. A. Tannapfel
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  5. J. Balli
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  6. M. E. Franklin
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  7. W. Hohenberger
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  8. F. Köckerling
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Online publication: 20 November 2000

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Schneider, C., Jung, A., Reymond, M.A. et al. Efficacy of surgical measures in preventing port-site recurrences in a porcine model. Surg Endosc 15, 121–125 (2001). https://doi.org/10.1007/s004640010069

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  • DOI: https://doi.org/10.1007/s004640010069

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