最大切開創5mmで行う左側大腸病変に対する経直腸標本摘出を伴うreduced port surgery（RPS）

Reduced port surgery（RPS） for left-sided colorectal disease with transanal extraction of the specimen performed with a maximum incision wound of 5mm

◆要旨：【目的】左側大腸病変に対してreduced port surgery（RPS）とnatural orifice specimen extraction（NOSE）を融合させることで腹壁破壊を最小限とする．【方法】腹腔内で腸管を離断し，標本を経肛門的に摘出する．自動吻合器のアンビルを腹腔内で口側腸管に固定し，完全腹腔内吻合を行う．【成績】2012年3月から2013年10月まで12例に本法を施行した．Clavien-Dindo分類GradeⅡの縫合不全を1例，遅発性の吻合部狭窄を2例に認めた以外は経過良好であり，術後の鎮痛剤もほとんど必要としなかった．【結論】本術式は標本摘出のための腹壁破壊が不要であるとともに，体内で自動縫合器を使用しないため12mmポートを必要としない．最大切開創は5mmであり，整容性のみならず侵襲の面でも患者満足度の高い手術である．

【Objective】 Reduced port surgery（RPS） for colorectal cancer has been developed as one of the minimal invasive surgeries. We have performed RPS for left-sided colorectal disease with transanal extraction of the specimen to reduce abdominal wall destruction. 【Methods】 Lymph node dissection and mobillization of the left-sided colon were performed in the conventional laparoscopic manner. We resected the specimen with using transanal extraction through Alexis^® Wound Retractor XS. The anvil head was inserted into the abdominal cavity and anastomosis was performed with totally laparoscopic technique. 【Result】 Twelve patients underwent RPS with transanal extraction of the specimen from March. 2012 to October.2013. Only one case was complicated by anastomosis leakage and two cases had late onset anastomotic setenosis. Other patients had good progress and most patients did not require a pain-killer. 【Conclusion】 RPS with transanal extraction of the specimen appears to be feasible, cosmetic and less invasive than conventional laparoscopic assisted colectomy.