The aim of this study was to explore the use of gasless single-port laparoscopic-assisted surgery (GSLR) in rectal cancer surgery in a prospective study in 186 patients. The results of this study showed that the GSLR procedure does not affect the exposure of important anatomical locations during surgery and does not interfere with the surgical procedure. Moreover, GSLR has less effect on cardiopulmonary function during surgery and faster recovery of wound pain and gastrointestinal function in the postoperative period. During the postoperative recovery, our results showed that the GSLR procedure had less impact on the patient's immune cells and lung infections.
Clinical treatment of rectal cancer continues to rely on surgery, chemotherapy, radiotherapy, and typically signal-targeted therapy (14). In many countries, laparoscopic surgery has become one of the optional treatments for rectal cancer (15). Previous studies have shown that the survival benefit of laparoscopic surgery is encouraging and supports the routine use of laparoscopic surgery in adult patients with rectal cancer in the current era of minimally invasive surgery (16). Carbon dioxide pneumoperitoneum is the classic method of surgical field exposure in laparoscopic surgery (17), which is usually safe and effective but has some disadvantages. First, elevated abdominal pressure increases cardiac preload and afterload, thereby decreasing cardiac function (18–20). Second, respiratory function may be impaired due to elevated intrathoracic and airway pressures (21). In addition, pneumoperitoneum may lead to hypercapnia, internal environment disorders, and even life-threatening complications such as gas embolism and renal dysfunction (22–24). Therefore, it is necessary to find a new minimally invasive surgical procedure to improve the adverse effects of pneumoperitoneum in conventional laparoscopic rectal cancer surgery.
The GSLR procedure is an excellent solution to the effects of pneumoperitoneum on patients. Previous studies have shown that the GSLR procedure is a safe, effective and minimally invasive treatment in gynecologic surgery, with associated savings in medical costs (25). Intriguingly, studies have shown that even pregnant women can tolerate various GSLR surgeries, avoiding hypercapnia and elevated intra-abdominal pressure due to gas insufflation (26). However, the GSLR surgery has not been explored in the context of radical resection for rectal cancer.
In our study, a total of 186 patients underwent minimally invasive radical resection of rectal cancer, of whom 90 underwent GSLR. Our results show that the GSLR does not affect the exposure of the surgical field, and it is able to visualize the critical anatomical areas well, facilitating the surgical procedure. In our study, there was no significant difference between patients in the GSLR and LR groups in terms of parameters such as age, sex, and BMI. As shown in Table 2, our results demonstrated that CVP and PIP were lower in the GSLR group at 1 h from the start of surgery and at 10 min from the end of surgery than in the LR surgical group. This indicates that the GSLR surgery had less impact on the cardiopulmonary function of the patients than the LR group. We also found that patients in the GSLR group recovered earlier from postoperative anal defecation and had less postoperative pain than those in the LR group. In Fig. 2, we also found that the surgical scar was smaller in the GSLR group. Moreover, the results of this study showed that the effect of GSLR on CD3+, CD4+, CD8 + cells of the patients was also less on postoperative day 1 and postoperative day 7 (Table 4). As shown in Table 5, in terms of postoperative complications, the results of the present study also showed that there were fewer complications of lung infection in the GSLR group compared with the LR procedure.
This study also has some limitations. First, the number of people included in this study is small, and a large sample is needed to confirm the results. Second, the results of this study are only for the Chinese population, and further research is needed for other ethnic groups. Third, the results of this study are only applicable to radical resection for rectal cancer, and further research is needed for other types of surgery.
In conclusion, the GSLR procedure in radical rectal resection does not interfere with the surgeon's operation and is effective in exposing key anatomical sites during surgery, while having less impact on the patient's cardiopulmonary function during surgical anesthesia. In the postoperative recovery process, the GSLR surgery also restored the patient's postoperative gastrointestinal function and T-cell subpopulations earlier compared with the LR surgery. Therefore, the GSLR surgery offers a new surgical treatment option for suitable rectal cancer patients.