Transumbilical single port laparoscopic sigmoidectomy for diverticulosis

Transumbilical single incision laparoscopic sigmoidectomy is feasible by experienced laparoscopic surgeons using current available laparoscopic instruments and staplers. In this live video shot during the IRCAD Advanced Course in Laparoscopic Colorectal Surgery in November 2009, Prof. Leroy shows an extraordinary single port sigmoidectomy.

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Transumbilical single port laparoscopic sigmoidectomy for diverticulosis

Authors

J Leroy, J Marescaux

Abstract

Transumbilical single incision laparoscopic sigmoidectomy is feasible by experienced laparoscopic surgeons using current available laparoscopic instruments and staplers. In this live video shot during the IRCAD Advanced Course in Laparoscopic Colorectal Surgery in November 2009, Prof. Leroy shows an extraordinary single port sigmoidectomy.

Classification

single port

Keywords

Transumbilical single port laparoscopic sigmoidectomy, diverticulosis

Media type

Surgical video

Duration

11'10''

Publication

2009-12

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E-publication

WeBSurg.com, Dec 2009;9(12).
URL: http://www.websurg.com/doi-vd01en2820.htm

Transumbilical single port laparoscopic sigmoidectomy for diverticulosis

1. Port system presentation 00'19''

First I want to show you the new approach we will do. It is a hand coming from the abdomen with a particular finger at the tip. We have introduced and re-enter inside the hole there. We introduce the new Ligasure®. I will do as we do for diverticulosis, a sigmoid resection. I am working without crossing my hands, but it is important to know when we do this surgery that we have to have more and more ergonomics, that is why robotics will perhaps develop. But we have some easier solutions and tricks that I will try to reproduce today. How big is the incision in the abdominal wall? We have begun with 2cm, but we try to do less if possible.

2. Colon dissection 02'54''

I have to free laterally to better see what I have to do. This is where we can use scissors, curved scissors eventually if you want, but I prefer to continue with this device. You can choose different instruments, you can choose disposable scissors. Do you still use your 0 degree optic? No, finally I prefer to use an angled scope, but they gave me a 0 degree scope. The size is six. Come back down to continue the dissection, you see the difference of colour with the sigmoid. We will soon have reached where we want to do the dissection. I am now calling the gastroenterologist. I suppose I will do the anastomosis at this level. Without mobilizing of course the splenic flexure. I never do it in 80% of cases. I free laterally and it is enough. I have to remove this, we will use a clamp.

3. Anvil introduction 05'12''

I will do a puncture of the colon, I will introduce the sutures inside the colon, and under colonoscopy, we will catch the sutures and pull through the anus. I will attach the anvil and the peak of the anvil and pull proximally where I will do the anastomosis. I have two instruments, right and left hand, and as you see I have no real conflict while working and no outside conflict as well. I will do a puncture. I’m now introducing a suture. I’m clamping once more this and ask my assistant to come back. See the inside view of the colon. The assistant catches the suture. So you pull. How long is the thread? It’s very long. It’s 40cm long. I will fix. Now let’s introduce the anvil inside of the rectum. It’s necessary to have outside contratraction as you can see. This is why perhaps, I think, we have to do it before the dissection because it seems that it is more spastic afterwards. The peak of the anvil is there.

4. Colon division and anastomosis 07'38''

I’m trying to apply a correct traction and now I’ll change the scope to have a 5mm dividing the colon there. We introduce the stapler through the same hole and the scope afterwards. Now we will divide distally changing good exposure by our assistant. Can you pull on the thread? Here we go. You can perforate here. I’m firing now. It’s good and beautiful. Tension-free. We remove this now. Now we close.