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Transumbilical single incision laparoscopic total colectomy and partial proctectomy with ileorectal anastomosis

This video demonstrates our transumbilical three-trocar technique for single incision total colectomy and partial proctectomy with intracorporeal side-to-end ileorectal anastomosis using standard laparoscopic instrumentation. The patient is a thin 19-year-old boy with a BMI of 19 presenting with familial adenomatous polyposis (FAP). The previous colonoscopy has shown 300 polyps in the colon and very few in the distal rectum. Conventional trocars (5mm, 10mm, and 12mm) are used through a 3.5cm transumbilical incision. The ligation of the vessels is mostly carried out by the Ligasure-V vessel-sealing device using a medial-to-lateral approach. The specimen is extracted through the umbilical incision after removal of the 10mm and 12mm cannulas. The ileorectal anastomosis is carried out intracorporeally using a double stapling technique.

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Transumbilical single incision laparoscopic total colectomy and partial proctectomy with ileorectal anastomosis

作者群

JR Ramos, R Mesquita Machado, EA Valory, AH Creiler

摘要

This video demonstrates our transumbilical three-trocar technique for single incision total colectomy and partial proctectomy with intracorporeal side-to-end ileorectal anastomosis using standard laparoscopic instrumentation. The patient is a thin 19-year-old boy with a BMI of 19 presenting with familial adenomatous polyposis (FAP). The previous colonoscopy has shown 300 polyps in the colon and very few in the distal rectum.
Conventional trocars (5mm, 10mm, and 12mm) are used through a 3.5cm transumbilical incision. The ligation of the vessels is mostly carried out by the Ligasure-V vessel-sealing device using a medial-to-lateral approach. The specimen is extracted through the umbilical incision after removal of the 10mm and 12mm cannulas. The ileorectal anastomosis is carried out intracorporeally using a double stapling technique.

分類

contribution

關鍵字

Transumbilical single incision laparoscopic total colectomy, partial proctectomy, ileorectal anastomosis

媒體類型

手術影片

期間

10'48''

刊物

2010-09

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, Sept 2010;10(09).
URL: http://www.websurg.com/doi-vd01en3033.htm

Transumbilical single incision laparoscopic total colectomy and partial proctectomy with ileorectal anastomosis

1. Introduction 00'18''

A 3.5cm vertical transumbilical incision is used to place the three trocars (Figure No. 1.b-c). The 10mm trocar is entered under direct vision and a straight 10mm, 30-degree scope is connected to a high definition camera (Image 1–Hub-Storz). The abdomen is insufflated with carbon dioxide at a pressure of 14mmHg.

2. Right colon resection 00'40''

The patient is placed in a left lateral position and the surgical team stands to the patient’s left side (Figure No.2).

3. Ileocolic vessels dissection 01'16''

The ileocolic vessels are dissected using 5mm articulated scissors and sealed with the 5mm Ligasure-V device (Covidien Ltd, Norwalk, Conn, USA) through cannula No.2 (5mm) using a medial-to-lateral approach.

4. Right colon and terminal ileum mobilization 03'54''

The entire right colon and terminal ileum are mobilized this way using the 5mm straight grasper through cannula No.3 (5-12mm) and the 5mm scissors or the 5mm Ligasure-V device through cannula No.2. This allows to obtain a sufficient intracorporeal triangulation and to perform the dissection in compliance with laparoscopic standards. Finally, the right side colo-omental attachments are freed.

5. Transverse colon resection 04'49''

After identification of the pancreatic tail and of the duodenum, the root of the transverse mesocolon will be exposed. Access will be gained to the lesser sac close to the duodenojejunal junction.

6. Middle colic vessels division 05'39''

The middle colic vessels and the transverse mesentery are divided and sealed using a medial approach as soon as the patient is placed in a reverse Trendelenburg position. The surgeon stands between the patient‘s legs (Figure No. 3). At this time in the procedure, the scissors or the Ligasure-V device, used through cannula No.3, and the grasper, used through cannula No.2, can be visualized. Once again, the surgeon and the cameraman change their position (Figure No.4). The 5mm grasper through cannula No.2 is used for traction, and the scissors or the Ligasure-V device through cannula No.3 are used to seal the omental attachments and the mesentery.

7. Left transverse colon and splenic flexure mobilization 06'08''

The left transverse colon and the splenic flexure are then taken down using a superior approach, the patient lying in a reverse Trendelenburg and a right lateral position.

8. Left colon and rectal resections 07'22''

The patient is then placed in a Trendelenburg and right lateral position.

9. Left and sigmoid vessels division 08'21''

The left colic vessels and the sigmoid trunk vessels are identified and ligated. The superior rectal vessels and the mesorectum are preserved in order to protect the hypogastric and pelvic nerves.

10. Rectal division 10'02''

After total mobilization of the vertical segment of the rectum, a linear articulated stapler is used to transect the rectum through the 12mm cannula.

11. Specimen retrieval and external ileal division 10'16''

The specimen is retrieved through the umbilical incision and the terminal ileum is transected outside the abdomen. The anvil of a circular stapler is introduced in the ileum and reinserted in the peritoneal cavity.

12. Ileorectal anastomosis 10'33''

The ileorectal anastomosis is performed transanally using a double stapling technique. A drain is then placed in the pelvis and the umbilical incision is closed. The operative time was 5 hours. The three trocar technique does not provide an adequate independence of movement for retraction and triangulation during the rectal operative steps.