Transanal specimen extraction with endorectal plastic sleeve protection after sigmoidectomy for diverticulitis

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摘要

The objective of this film is to demonstrate a technique for transanal extraction using a plastic protection sleeve at the rectal level after sigmoidectomy for sigmoid diverticulitis.

關鍵字

Transanal specimen extraction, endorectal plastic sleeve protection, sigmoidectomy, diverticulitis

媒體類型

期間

07'06''

刊物

2011-02

普通的

最愛

音訊

副標題

數位出版

WeBSurg.com, Feb 2011;11(02).
URL: http://www.websurg.com/doi-vd01en3098.htm

Transanal specimen extraction with endorectal plastic sleeve protection after sigmoidectomy for diverticulitis

1. Introduction 00'10''

The objective of this film is to demonstrate a technique for transanal extraction using a plastic protection sleeve at the rectal level.

2. Partial colonic division 00'21''

Once the sigmoid mesocolon has been divided and the lower sigmoid has been ligated prior to cleansing the rectum with a Betadine solution —at least 1 liter of saline—, a partial division is carried out on the right border just above the colorectal junction.

3. Rectal suspension 00'58''

The rectum is then suspended by means of a stitch introduced through a 12mm port in the right iliac fossa.

4. Colonic division and plastic sleeve introduction 01'05''

Division is completed and the introducer of the plastic sleeve can be seen in the rectal stump. It is situated in the rectal lumen. This semi-rigid plastic introducer, 10mm in diameter, is pushed into the abdominal cavity. The plastic sleeve and the plastic bag are then brought inside the abdominal cavity. This 1.5-liter bag is then withdrawn by its distal extremity through the rectal wall until it is exteriorized beyond the anus.

5. Colonic stump ligation 02'12''

Once the colonic stump has been ligated using a well fastened Vicryl loop, a forceps is introduced in the plastic sleeve, which is maintained open by its metallic Nitinol loop.

6. Bowel segment exteriorization 02'24''

The bowel segment is then pulled through the plastic bag. This has a major advantage, as it allows for the easy sliding of the bowel segment that will be exteriorized through the anus, itself protected by the plastic sleeve.

7. Anvil introduction 03'00''

Once a colotomy has been performed and once the anvil has been introduced in the proximal colon, the anvil being attached by a Polysorb 2 suture, the colon is divided close to the healthy area that has been previously identified in order to achieve a colorectal anastomosis. It may be observed that the specimen extraction can be performed easily through the plastic sleeve, which will then be removed using transanal traction. The bowel segment can be maintained in this plastic sleeve, which is closed prior to extraction. Once the specimen has been extracted, a partial closure is carried out using 3 separate stitches of Ethibond 2/0, respectively situated on the hepatic flexure, the splenic flexure and the medial portion of the rectum.

8. Rectal stump closure 04'15''

This allows for a better exposure and placement of the stapler. A new generation of the Endo-GIA Ultra™ stapler is used here. It allows for the stapling with a purple cartridge, providing a caliber for closure comprised between the blue cartridge and green cartridge. A second closure can be seen here. It is performed with a second stapler, with a tan cartridge, which allows for the correct closure of the rectal stump.

9. Anvil exteriorization 05'21''

The anvil still remains to be brought out. To do so, the hook is introduced at the antimesenteric border. The suture is then searched for. It is stuck in the colon. This suture needs to be removed in order to bring the anvil as close to the stapling line as possible on the antimesenteric border. It can be noted that gentle traction allows here to exteriorize the anvil progressively. This should not be done too fast. Indeed, it is preferable to preserve a seromuscular cone, which will ensure an adequate closure and patency thanks to the placement of a Vicryl loop. The anastomosis still needs to be performed. It is carried out by bringing out the tip of the Endo-GIA stapler, which will be connected to the anvil. A small recut is necessary here. Patency is granted by a Vicryl loop likewise. The rod and the anvil should now be connected. An end-to-end Knight-Griffen colorectal anastomosis can be performed.

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