Laparoscopic caecal wedge resection combined with intraoperative colonoscopy for flat polyp

The objective of this film is to demonstrate a wedge resection of the right anterior colonic wall carried out to manage a flat polyp. A Surgiquest™ Airseal™ 12mm trocar is used for that purpose, along with two other trocars: a suprapubic trocar and an epigastric trocar. Two 12mm trocars are used: one of them is placed at the level of the umbilicus, and the other one is positioned in the epigastric region. The third trocar is a 5mm one. It will be placed in a suprapubic position.

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Laparoscopic caecal wedge resection combined with intraoperative colonoscopy for flat polyp

Authors

J Leroy, Gf Donatelli, J Marescaux

Abstract

The objective of this film is to demonstrate a wedge resection of the right anterior colonic wall carried out to manage a flat polyp. A Surgiquest™ Airseal™ 12mm trocar is used for that purpose, along with two other trocars: a suprapubic trocar and an epigastric trocar. Two 12mm trocars are used: one of them is placed at the level of the umbilicus, and the other one is positioned in the epigastric region. The third trocar is a 5mm one. It will be placed in a suprapubic position.

Keywords

Laparoscopic caecal wedge resection, intraoperative colonoscopy, flat polyp

Media type

Surgical video

Duration

04'00''

Publication

2011-02

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E-publication

WeBSurg.com, Feb 2011;11(02).
URL: http://www.websurg.com/doi-vd01en3123.htm

Laparoscopic caecal wedge resection combined with intraoperative colonoscopy for flat polyp

1. Introduction 00'10''

The objective of this film is to demonstrate a wedge resection of the right anterior colonic wall carried out to manage a flat polyp. A Surgiquest™ Airseal™ 12mm trocar is used for that purpose, along with two other trocars: a suprapubic trocar and an epigastric trocar. Two 12mm trocars are used: one of them is placed at the level of the umbilicus, and the other one is positioned in the epigastric region. The third trocar is a 5mm one. It will be placed in a suprapubic position.

2. Abdominal cavity exploration 00'54''

The procedure starts with the exploration of the abdominal cavity.

3. Intraoperative colonoscopy 00'58''

The terminal small bowel is clamped and the endoscopist performs a colonoscopy in order to prevent the bowel from inflating. The endoscopist reaches the caecum. He then goes backwards and finds the polyp formation at the anterolateral level of the ascending colon, around 10cm above the ileocaecal valve.

4. Transillumination for polyp identification 01'29''

Transillumination makes the identification easier. Fixation stitches are placed on the internal and external borders of the flat lesion, which is situated over an anterior mucosal fold.

5. Stitch placement 02'05''

The first stitch is placed here. A colonoscopic control of the needle passage route, which must be outside the limits of the polyp, is carried out. The external stitch is outside the polyp. It will be controlled endoscopically.

6. Transversal wedge resection 02'35''

Once the identification stitches have been placed, a transversal wedge resection of the anterolateral wall of the ascending colon is performed 8 to 10cm above the ileocaecal junction. This is made possible due to the large size of the caecum. The Endo-GIA linear stapler, blue cartridge, is used here. Two firings will be necessary, as the resection will be carried out beyond the limits of the identification stitches.

7. Specimen extraction 03'16''

The resected segment is then placed in a plastic bag, which is introduced through one of the 12mm trocars. The bag —an Endocatch Gold®— is then closed. After exteriorization, it is compulsory to examine the specimen in order to check the resection margins and to verify that the whole polyp has been resected in a healthy area, as it is the case in this patient. This can be well seen in these pictures.