With this method, a small
laparotomy is first conducted according to the size of the exposed affected intestinal tract or
tumor size, prior to the application of a LAP DISC (LD) to the
wound and introduction of a 12-mm
trocar for the establishment of
pneumoperitoneum. The method is advantageous in that organ injury and vessel injury are avoided when the small
laparotomy is conducted first, and prompt transition to a conventional
laparotomy is possible. The diaphragm of the iris bulb can be controlled in a non-stepwise manner. In addition,
trocars, the stapler, and other instruments, can be inserted under the
pneumoperitoneum. Furthermore, the use of a 5-mm flexible scope allows surgical maneuvers, except for application of LD, to be conducted via 5-mm
trocars. In addition, the 5-mm scope can be inserted through any
trocar, allowing multidirectional avoidance of dead space and intraperitoneal observation. When only 5-mm
trocars are used, it is not necessary for the sites of
trocar puncture to be closed by
sutures, and this minimizes the risk of adhesions and port-site herniation. The method is also considered to be excellent from the point of view of esthetics.
RESULTS: We employed this surgical approach in 50 patients with
colorectal cancer at our hospital. None of the patients developed any traumatic complications associated with the insertion of
trocars, and none of the patients, even those with a past history of abdominal operation, required conversion to conventional
laparotomy.
CONCLUSIONS: Based on these results, this method involving a small
laparotomy prior to the application of an LD and introduction of a 12-mm
trocar for establishing
pneumoperitoneum, with the efficient use of a 5-mm flexible camera, is considered to be safe and useful for laparoscopic excision of the large intestine.