Single-port endoscopic mesocolic and mesorectal excision using an extraperitoneal approach.
BACKGROUND
The extraperitoneal rectal dissection via a transanal approach facilitates the mesorectal dissection. The retroperitoneal approach for mesocolic excision may also offer some similar advantages. To complete the lymphadenectomy of extraperitoneal mesorectal resection, we developed an innovative approach for upper rectal and mesocolic excision via an exclusive retroperitoneal dissection using a single-port access at the site of the future stomy.


METHODS
This study was a prospective pilot study and was conducted between 2013 and 2015 at two oncologic centers. Five consecutive patients, with ano-rectal cancer requiring permanent stoma, underwent this procedure.


RESULTS
The bowel was never touched or mobilized to perform the lymphadenectomy, and no Trendelenburg was required. The median operative duration was 300 min (range 205-310). The quality of the surgical plane was classified as good (mesorectal) in the five patients. The median circumferential and distal margins were, respectively, 5 mm (range 1-20) and 20 mm (range 5-25). The median number of harvested lymph nodes was 11 (range 5-18). No laparotomy or multiport laparoscopy was required. There was no death. Two patients had perineal wound dehiscence (one minor and one major).


CONCLUSIONS
The mesocolic excision via a retroperitoneal approach is feasible, completes naturally the transanal mesorectal excision and may confer several advantages including no morbidity of small bowel manipulation or Trendelenburg position. Further studies are required to analyze this approach.
['Dumont|F|F|', 'Thibaudeau|E|E|', 'Benhaïm|L|L|', 'Gouy|S|S|', 'Labbe|D|D|', 'Honoré|C|C|', 'Goéré|D|D|']
D000230:Adenocarcinoma D000368:Aged D001005:Anus Neoplasms D002294:Carcinoma, Squamous Cell D013505:Digestive System Surgical Procedures D005260:Female D006801:Humans D010535:Laparoscopy D008197:Lymph Node Excision D008297:Male D008545:Melanoma D008643:Mesentery D008646:Mesocolon D008875:Middle Aged D010865:Pilot Projects D011446:Prospective Studies D012004:Rectal Neoplasms D012007:Rectum D000067368:Transanal Endoscopic Surgery
Extraperitoneal Retroperitoneal Mesocolic excision Transanal mesorectal excision Rectal cancer Single port