Useful Preoperative Simulation of Laparoscopic Surgery for Rectal Cancer in Patients with Kyphosis

Kyphosis complicates abdominal surgery. Here, we report a case of rectal cancer in a patient with kyphosis who underwent successful laparoscopic surgery after a preoperative simulation. An 81-year -old woman with rectal cancer was admitted to our department, and laparoscopic surgery was planned. Physical examination revealed severe kyphosis. To ensure successful laparoscopic surgery, we conducted a detailed preoperative simulation, including three-dimensional CT simulations of port arrangement and anatomy, simulation of body position, selection of surgical instruments, and preoperative discus-sion with the anesthesiologist. We planned to insert the first port in the umbilical region for pneumop-eritoneum and the camera port in the ventral region under pneumoperitoneum. We planned to insert the ports on the right side of the patient's body from the caudal regions, after considering the location of the inferior mesenteric artery and the limitations in degrees and space attributable to the costal arch and promontorium. Beach chair position was planned. We used a fan-shaped retractor and sponge re-tractor to remove the small intestine from the surgical view. In preoperative discussions with the anes-thesiologist, we decided to maintain pneumoperitoneum pressure at less than 8 mm Hg during the op-eration, to safeguard respiratory function. Lower anterior resection with D2 lymph node dissection was performed, without intraoperative complications. At 2 years postoperatively, the patient was healthy with no signs of recurrence. Laparoscopic surgery appears to be a suitable choice for patients with kyphosis. We believe that preoperative simulation will result in successful outcomes. (J Nippon Med Sch 2022; 89: 634?639)

Automated summary

This report presents a case of successful laparoscopic surgery in a patient with kyphosis who had rectal cancer. Detailed preoperative simulation and discussions were conducted to ensure a successful outcome.