Minilaparotomy using the Moving Window Method for Radical Operation in the Treatment of Colorectal Cancer is Minimally Invasive and Safe to be used by General Surgeon

Eiji Takeuchi, Yoichirou Kobayashi, Kanji Miyata, Norihiro Yuasa, Yasutomo Goto, Hideo Miyake, Keiichi Nagasawa, Atsushi Yasue, Takamasa Takahashi and Takashi Miyake

Department of General and Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital

Purpose: We analyzed short-term endpoints of minilaparotomy using the moving window method for radical surgery in the treatment of colorectal cancer. Methods: Between December 2002 and March 2007, 175 patients were scheduled to undergo resection for colorectal cancer via a 7 cm minilaparotomy using the moving window method at our institution. The ratio of the all radical surgery (606 cases) for colorectal cancer during the same period at our institution was 29%. Stapled anastomosis -functional end-to-end anastomosis or double stapling- was used. Result: Of 21 surgeons conducting the operation, 12 with 3-9 years of postgraduate experience undertook 69 cases (39%). The wound length was elongated to 10 cm in 39 cases (22%). Mean operating time was 127 minutes and mean bleeding volume was 97 ml. One patient (0.6%) had an intraoperative complication involving a bowel injury caused by the stapler, necessitating reoperation on postoperative day (POD) 1. Some 27 patients (15%) had postoperative complications, common by intestinal obstruction (11 cases, 6%), surgical site infection (4 cases, 2%), and retrograde infection of the drainage tube (3 cases). No anastomotic leakage occurred. Two patients died while hospitalized -one peritonitis due to cancer and one fron pneumonia due to Alzheimer's disease. Seventy-five (91%) of 82 patients for whom a clinical pathway was used were discharged in line with the pathway. The mean postoperative hospital stay was 14 days. Conclusions: Minilaparotomy using the moving window method is a procedure under direct vision similar to ordinary three-dimensional laparotomy, and is safe and minimally invasive suitable for general surgeons.

Key words
minilaparotomy, moving window method, functional end-to-end anastomosis, minimally invasive surgery, surgical site infection

Reprint requests
Eiji Takeuchi Department of General and Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital
3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511 JAPAN

Accepted
September 26, 2007

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