Application Of "Cai’s Three-step Maneuver" Based On Membrane Anatomy In Intestinal Tube Mesentery Baring Of Laparoscopic-assisted Natural Orifice Specimen Extraction Radical Left Colorectomy

Objective To evaluate the application value of “Cai’s three-step maneuver” in laparoscopic-assisted radical left colorectomy transanal specimen extraction with the guidance of membrane anatomy.Methods The clinical data of 20 patients were retrospectively study who underwent laparoscopic-assisted radical left colorectomy transanal specimen extraction by Cai’s three-step maneuver in gastrointestinal surgery department of Zhongshan Hospital Affiliated to Xiamen University from November 2017 to January 2019,including the operation time,proximal and distal intestinal tube mesentery naked time and intraoperative estimated blood loss,the number of lymph node cleaning,each cutting edge distance from tumor,the negative rate of peripheral incision;postoperative pain [Visual Analogue Score(VAS)was used for the pain Score],bed activity time,time of anal exhaust,postoperative feeding time,length of hospital stay,postoperative complications,anal function and other indicators.The patients were followed up by outpatient service,WeChat and telephone as of February 2019.Results All patients successfully completed the operation,no transfer to open surgery or traditional laparoscopic surgery.The average total operative time was(212.5±45.8)min,the average proximal intestinal tube mesentery baring time was(33.8±5.3)min,the average distal intestinal tube mesentery baring time was(26.8±6.2)min,and the intraoperative blood loss was(40.5±17.0)ml.The average number of lymph nodes dissected per patient was(15.4±7.0).The average distance between the far and near cutting edge and the tumor was(5.3±0.9)cm and(10.1±1.6)cm,respectively.The negative rate of circumferential cutting edge was 100%.Postoperative average pain score(2.6±1.0)score,first time out of bed activity(2.3±1.1)d,the first day of the patient’s anal exhaust time after surgery was(3.2±0.8)d,the first postoperative fluid diet time was(5.3±2.2)d,and the postoperative hospitalization time was(11.7±5.7)d.One patient presented anastomotic microfistula after surgery,which was cured and discharged after conservative treatment.All 20 patients were followed up,with a median follow-up of 7 months(1~16 months).No other complications or tumor recurrence or metastasis were found during the follow-up period,and no patient died during the follow-up period.from November 2017 to January 2019.Conclusion “Cai’s three-step maneuver” can simplify the procedure of the intestinal tube mesentery baring in laparoscopic-assisted radical left colorectomy transanal specimen extraction,reduces the difficulty of the intestinal tube mesentery baring,reduce the difficulty of baring,conforms to the requirements of membrane anatomy,and have good clinical application value.