A world premiere: Single port sigmoidectomy for diverticulosis in humans

This video shows a unique procedure during which a sigmoidectomy was performed with a single trocar and entirely through the umbilicus. The principles applied to benign colonic resections are respected. An original colo-colonic anastomosis is presented with the use of external magnets to aid in with the totally intracorporeal anastomosis. The postoperative cosmetic results are shown.

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A world premiere: Single port sigmoidectomy for diverticulosis in humans

Authors

J Leroy, J Marescaux

Abstract

This video shows a unique procedure during which a sigmoidectomy was performed with a single trocar and entirely through the umbilicus. The principles applied to benign colonic resections are respected. An original colo-colonic anastomosis is presented with the use of external magnets to aid in with the totally intracorporeal anastomosis. The postoperative cosmetic results are shown.

Classification

tips and tricks, single port

Keywords

single port sigmoidectomy: tips and tricks for exposure and anastomosis

Media type

Surgical video

Duration

05'46''

Publication

2008-10

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E-publication

WeBSurg.com, Oct 2008;8(10).
URL: http://www.websurg.com/doi-vd01en2395.htm

A world premiere: Single port sigmoidectomy for diverticulosis in humans

1. Clinical case presentation 00'02''

In this video, we present how we did a sigmoidectomy using only one trocar without any other percutaneous assistance and a trans-anal approach for the anastomosis.

2. Trocars 00'21''

The first step is to introduce a trocar that is mainly a sleeve, inserted using an introducer through the umbilicus. The opening is performed using a mini-open approach. It is a sleeve that is well fixed to the abdominal wall by 2 rings, one posterior and another anterior. We also have 3 channels to introduce instruments: two 5mm and one 12mm, and another one to insufflate the abdominal cavity. We use an angle scope 10mm, 5mm, 3mm manufactured by Karl Storz, and flexible instruments to grasp, dissect, and divide. We also use the Ligasure Advance® device that can be used in a monopolar Valleylab mode and bipolar Ligasure.

3. Introduction of the anvil 01'56''

After having exposed the meso using a flexible retractor, we divide it using the Ligasure advance® proximal to the bowel because it is a benign disease. When we have finished dividing the meso, we introduce the stapler’s anvil using the Karl Storz dual channel colonoscope, and the anvil is pushed above the segment that we want to resect in the proximal descending colon. This is controlled and checked under laparoscopic control, and with the aid of the forceps, the anvil is pushed in the right place. Once pushed, the anvil is maintained in place with a magnet placed outside of the abdominal wall.

4. Colonic resection 02'52''

Using a scope with a smaller diameter, we introduce a 12mm Endo-GIA linear stapler with a blue cartridge to divide the colon underneath the anvil maintained by the magnet and at the superior limit of the sigmoid colon, we have to resect. The next step is the division of the colorectal junction that we will do under colonoscopic control. This division is done using a 3mm scope and an Endo-GIA with an articulated cartridge.

5. Anvil exposure and extraction 03'44''

The next step is to find the anvil that is still maintained by the magnet; due to the traction and magnetic field, the anvil is attracted and after we incise the colon, the anvil exits and we complete the closure around the shaft of the anvil using a loop.

6. Lateral mobilisation 04'22''

We have also mobilized the descending colon and freed the lateral attachments of the splenic flexure enough to be able to do a tension-free anastomosis.

7. Endoscopic view of the anastomosis 05'35''

An endoscopic control was also performed to check the stapling line under visual control.

8. Specimen extraction 05'44''

The segment of bowel is then introduced in a plastic bag and removed through the umbilical incision. Thirty centimetres of sigmoid were removed. At the end, we checked the scar, then one week later, the cosmetic result was perfect. The patient stayed 3 days in hospital.