WebSurg中文版尚未完成，翻譯工作進行中！

Totally laparoscopic sigmoidectomy for diverticulitis with transanal colonic removal

The objective of this film is to demonstrate the segmental resection of the sigmoid colon through a totally laparoscopic approach and without any mini-laparotomy for the specimen extraction. To do so, the specimen will be extracted transanally and the whole of the anastomosis will be carried out without any opening of the abdominal wall.

建立帳號

瀏覽全世界

繁體中文 ▼

Google translate

總結
章節
您的意見
詢問專家群

欲觀看此影片請先登入！

Totally laparoscopic sigmoidectomy for diverticulitis with transanal colonic removal

作者群

J Leroy, J Marescaux

摘要

The objective of this film is to demonstrate the segmental resection of the sigmoid colon through a totally laparoscopic approach and without any mini-laparotomy for the specimen extraction. To do so, the specimen will be extracted transanally and the whole of the anastomosis will be carried out without any opening of the abdominal wall.

分類

basic techniques

關鍵字

Totally laparoscopic sigmoidectomy, diverticulitis, transanal colonic removal

媒體類型

手術影片

期間

10'00''

刊物

2009-12

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, Dec 2009;9(12).
URL: http://www.websurg.com/doi-vd01en2771.htm

Totally laparoscopic sigmoidectomy for diverticulitis with transanal colonic removal

1. Introduction 00'19''

The objective of this film is to show the segmental resection of the sigmoid colon through a totally laparoscopic approach and without any mini-laparotomy for the specimen extraction. To do so, the specimen will be extracted transanally and the whole of the anastomosis will be carried out without any opening of the abdominal wall. Only three ports are used to begin the procedure in order to expose the sigmoid colon. Sigmoidectomy starts with the freeing of lateral attachments, especially due to inflammatory symptoms that legitimate the surgical indication.

2. Freeing of adhesions 01'22''

Here we can clearly see fairly loose and edematous adhesions of the sigmoid colon to the left lateral wall. Freeing of these adhesions is carried out using the monopolar scissors’ electrode (Roticulator™ Endo mini-shears™), which allows to isolate the sigmoid mesocolon perfectly.

3. Division of sigmoid branches 01'47''

The sigmoid branches are divided using the 10mm Ligasure Atlas® device introduced in the right iliac fossa through a 12mm port. The exposure is achieved once the right lateral attachments have been freed using a forceps also introduced in the right iliac fossa through a 5mm port. The sigmoid mesocolon is divided until below the rectosigmoid junction, by preserving the superior rectal vessels

4. Distal colon dissection 02'27''

The distal sigmoid colon will be dissected to achieve a perfect exposure of the lower sigmoid colon.

5. Distal colon ligation 02'48''

The latter is ligated using a 2/0 Ethibond loop, which allows to perform an extracorporeal knot and to exclude the rectal stump. The future anastomotic area is evaluated at the level of the proximal colon and the meso is divided while preserving the vascularization of the colonic segment that will be brought to the anastomosis. Here we can appreciate a very good vascularization of this very compliant bowel segment. Before performing an incision of the lower sigmoid colon, the rectal stump has been washed with a Betadine solution. Through the right iliac fossa port, one of the rectal stump margins is attached using Ethibond wire maintained in placed through the port: this helps to achieve traction and open the rectal stump lumen.

6. Anvil introduction 04'12''

The anvil of the DST PCEEA 28mm circular stapler is introduced. The anvil’s tip is connected to a thread. This anvil is pushed into the proximal colon where the anastomosis will be performed while maintaining the thread in place. We push far enough to achieve a division underneath the anvil’s tip. The colon is opened towards the anti-mesenteric flexure and using the “fishing” technique, we search for the thread that is drawn externally. It is not preferable to perform a division of the stapling area. Thanks to exteriorization in the external angle, we can complete the airtightness by placing a Vicryl loop using the Endo-Suture system. With regards to the bowel segment that is now completely isolated, we place a new Vicryl loop while keeping a long thread to serve as a landmark for this intestinal extremity.

7. Lower sigmoid colon completion 05'49''

The division of the lower sigmoid is completed using the monopolar scissors’ electrode. We then introduce an Endo-catch II measuring 15mm in diameter via the anus and push the bag into the abdominal cavity towards the left iliac fossa. We introduce the bowel segment in the bag and close the bag while keeping the thread out of the bag.

8. Transanal specimen extraction 06'53''

Once the bag is closed, we remove the anvil and the introduction system before pulling on the bag to bring it to the anus. The bag is then opened before pulling on the colon that is inside the bag to gradually reduce the bag’s volume and perform the exteriorization through the rectum. This avoids difficulties for the extraction. The procedure needs to be completed by another division of the rectum below the colorectal junction. The latter has been prepared at the beginning of the procedure in order to perform the division in a well-vascularized area. The resected segment is placed in a small Endo-catch Gold bag that can be extracted through a 12mm trocar.

9. Colorectal anastomosis 08'18''

The colorectal anastomosis now remains to be performed. We must first check that there is no tension at the level of the anastomosis, complete the colonic mobilization if need be, in order to obtain a tension-free anastomosis. The rectal stump is transfixed using the circular stapler’s tip and connected to the anvil. We then check that there is no twist, perform the anastomosis before controlling it with an air-test or an endoscopic control; if necessary, we complete the mobilization before closing the mesenteric defect.