Hand-assisted laparoscopic abdomino-perineal resection utilizing the planned end colostomy site

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Colorectal Surgery

Background:

• Low rectal cancer often requires abdominoperineal resection (APR).
• Minimally invasive approaches aim to reduce surgical morbidity.
• Hand-assisted laparoscopic surgery (HALS) offers tactile feedback in laparoscopic procedures.

Purpose of the Study:

• To assess the feasibility and outcomes of using the planned end colostomy site for the hand-assist device during hand-assisted laparoscopic abdominoperineal resection (HAL APR).
• To evaluate the oncological and short-term outcomes of this technique in patients with low rectal cancer.

Main Methods:

• Six patients with low rectal cancers, unsuitable for sphincter salvage, underwent HAL APR.
• The hand-assist device was placed over the planned colostomy site.
• Standard total mesorectal excision (TME) was performed, with specimen delivery via the perineal incision.

Main Results:

• Mean operative time was 213 minutes, with no intraoperative complications or conversions.
• One patient experienced post-operative ileus, which resolved spontaneously.
• Mean hospitalization was 6.8 days, with one parastomal hernia at 13.3 months follow-up.

Conclusions:

• HAL APR utilizing the planned stoma site is technically feasible.
• This technique avoids an additional incision, maintaining oncological comparability and similar short-term outcomes to standard laparoscopic surgery.
• It preserves the benefits of a minimally invasive approach for low rectal cancer treatment.