The Extraperitoneal Approach to Left-Sided Colorectal Rectal Resections: EXPERTS Procedure

Area of Science:

• Minimally Invasive Surgery
• Colorectal Surgery
• Surgical Oncology

Background:

• Transperitoneal colorectal resections present challenges, particularly in obese patients.
• The traditional head-down position can lead to serious complications like compartment syndrome.
• Alternative approaches are needed to improve safety and feasibility.

Purpose of the Study:

• To evaluate the safety and feasibility of a new extraperitoneal approach for anterior resections.
• To compare outcomes with traditional transperitoneal methods.
• To assess the benefits in terms of patient positioning and complication rates.

Main Methods:

• A novel extraperitoneal left-sided approach was performed in the supine position.
• A Gelpoint port was utilized via a 5 cm incision.
• Forty-one patients undergoing left colonic resections were prospectively selected over two years.

Main Results:

• The extraperitoneal approach demonstrated significantly lower peak airway pressures (10 cmH2O) compared to the head-down position.
• Early identification of the ureter and gonadal vessels was achieved (median 23 minutes).
• No intraoperative complications or 90-day postoperative mortality were observed; R0 resection was achieved in all cancer patients.

Conclusions:

• The extraperitoneal approach for left colonic resections is safe and clinically feasible.
• This technique facilitates early identification of critical retroperitoneal structures.
• It offers a viable alternative, potentially reducing complications associated with traditional methods.