Three-port laparoscopy-assisted colectomy for colorectal cancer using external traction with suspension suture

Background: Laparoscopy-assisted colectomy is accepted as a standard procedure for colorectal resection. There have been many attempts to minimize the invasiveness of the procedure by reducing the number of operating ports and changing the specimen retrieval windows. Indeed, the invasiveness of laparoscopy-assisted colectomy has been minimized with these attempts; however, the technical challenges have increased. The technical challenges are related to lack of retraction and triangulation, which is necessary to expose the appropriate surgical field for safe surgery. A new technique based on retraction and triangulation with suspension suture traction for laparoscopy-assisted colorectal surgery is presented. Methods: Between September and November 2009, 24 laparoscopy-assisted colorectal resections for adenocarcinoma were performed through 3 ports with external traction with suspension suture. The surgical technique is described herein, and the intraoperative and postoperative courses of the patients were assessed. RESULT:: There were no intraoperative complications, and no need to convert to open surgery. All the resection margins were clear and the mean distance of proximal and distal margins was 11.4 and 4.8 cm, respectively. The median number of lymph nodes examined was 20.7. There were 2 cases of postoperative bleeding, but no cases of leakage or strictures at the anastomosis site. Conclusions: This new, simple technique is feasible and safe. External suspension suture traction can create an appropriate operative field, allowing balanced traction and countertraction and meeting the needs for oncologic surgery. In addition, this technique can be applied to other types of laparoscopic surgery and will contribute to reducing the number of ports.