Laparoscopic single port reversal of Hartmann’s procedure

This video demonstrates the laparoscopic single port restoration of bowel continuity after Hartmann’s procedure. The key steps of the operation —namely stoma removal, preparation of the descending colon, dissection and recut of the rectal stump, and trans-sutural colorectal anastomosis— are demonstrated and described in the video. The original aspect of this technique is that the authors carry out the reversal Hartmann procedure using a single port introduced into the stoma site.

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Laparoscopic   single   port   reversal   of   Hartmann’s   procedure

Authors
O Raspado, E D'Errico, N Arfi
Abstract
This video demonstrates the laparoscopic single port restoration of bowel continuity after Hartmann’s procedure. The key steps of the operation —namely stoma removal, preparation of the descending colon, dissection and recut of the rectal stump, and trans-sutural colorectal anastomosis— are demonstrated and described in the video. The original aspect of this technique is that the authors carry out the reversal Hartmann procedure using a single port introduced into the stoma site.
Classification
single port
Keywords
Laparoscopic, single port, reversal of Hartmann’s procedure
Media type
Duration
12'01''
Publication
2011-10
Popular
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Audio
en
Subtitles
en
E-publication
WeBSurg.com, Oct 2011;11(10).
URL: http://www.websurg.com/doi-vd01en3455.htm

Laparoscopic   single   port   reversal   of   Hartmann’s   procedure

2. Operative technique 00'55''
Only the colostomy site will be approached in order to reduce parietal trauma. The colostomy is freed from its cutaneous, subcutaneous and aponeurotic adhesions. A 28mm anvil is inserted in the distal extremity of the colon and is fixed by a purse-string. The whole structure is then reintroduced into the abdominal cavity. The Glove Port is then introduced. It consists of an Alexis wall retractor® with a glove containing three 5mm trocars and one 12mm trocar used as one’s fingers. A 12mmHg pneumoperitoneum is created. Adhesions can then be found at the level of the pelvis and of the left parietocolic gutter. They are taken down using the 5mm Ligasure® vessel-sealing device. The patient is then placed in a Trendelenburg position with a right tilt. Adhesions in the pelvis between the bowel loops and the rectal stump are freed. The rectal stump is then freed completely and trimmed using the 60mm Endo-GIA linear stapler, green cartridge. The descending colon is then freed. The omentum is grasped and adhesions are taken down and the omental folds are freed. The left parietocolic gutter is then freed by opening the left Toldt’s fascia. Dissection is pursued towards the splenic flexure and the splenic attachments are divided. Dissection proves uneasy due to the previous detachments of the plane occurred during the Hartmann’s procedure. The transverse mesocolon is eventually detached while respecting the inferior pole of the spleen. The colon is adequately freed and tracted towards the pelvis so as to anticipate the absence of traction anastomosis. A trans-sutural, mechanical end-to-end colorectal anastomosis is carried out using the 28mm PCEEA circular stapler. Prior to stapling, a control is performed to check that the colon is not twisted. An air test is then carried out so as to check that there is no suture dehiscence. An ultimate peritoneal washing is achieved. The bowel loops are then placed back so as not to cause an occlusion in the mesocolic defect. The parietal orifice is closed using 2 aponeurotic running sutures as well as skin closure.