Single-scar laparoscopic colectomy with intracorporeal attachable and detachable instruments

Single Incision Laparoscopic Colorectal Surgery Using Conventional Laparoscopic Instruments: Initial Experience with 44 Cases

BACKGROUND

We aimed to retrospectively investigate the short-term outcome, technical feasibility, and safety of single incision transumbilical laparoscopic colorectal surgery (SITULCS) using conventional laparoscopic surgical instruments.

METHODS

From April 2009 to July 2012, 44 patients with colorectal tumors underwent SITULCS at our department by using conventional laparoscopic instruments. The operations included right hemicolectomy (n = 8), sigmoidectomy (n = 5), total colectomy (n = 4), anterior resection of rectal cancer (n = 23), and abdominoperineal resection of rectal cancer (n = 4). We accessed the intraperitoneal lesions by three trocars through a single triangle-shaped umbilical incision using conventional instruments.

RESULTS

We successfully completed SITULCS without specially designed instruments. No patient was converted to multiport laparoscopic surgery or open surgery. Only one case developed intraoperative bleeding and one postoperative adhesive intestinal obstruction.

CONCLUSION

Our experience shows that SITULCS using conventional instruments is feasible, safe, and convenient.

Single-access laparoscopic colectomy utilizing gravity in the lateral decubitus position

BACKGROUND

Only a limited number of instruments can be used in single-access laparoscopic colectomy, and triangulation must be forfeited to avoid instrument collision. We investigated whether this problem could be overcome by performing laparoscopic colectomy by the use of the lateral decubitus position, making full use of gravity.

OBJECTIVE

The aim of this study was to determine whether single-access laparoscopic colectomy could be achieved while maintaining patients in the lateral decubitus position.

DESIGN

This was a prospective study.

SETTING

This single-center study was conducted in a hospital.

PATIENTS

Ten consecutive patients (4 men and 6 women) with stage II or III colon cancer were included.

INTERVENTIONS

Each patient was placed in the lateral decubitus position. Single-port access to the abdomen was provided by a 3.0-cm incision at the umbilicus. The roots of the supplying or draining vessels were isolated and divided for lymphadenectomy. Next, the colon was dissected from a lateral approach, without the help of the assistant. The specimen was extracted from the single-access incision. Extracorporeal or intracorporeal anastomosis was performed.

MAIN OUTCOME MEASURES

The primary outcome measured was the feasibility of single-access laparoscopic colectomy in the lateral decubitus position.

RESULTS

There were no intraoperative complications and no need for conversions to conventional laparoscopic surgery, open surgery, or the supine position. The median total surgical time was 154 minutes (interquartile range, 135-220 minutes). Surgical blood loss was slight (<20 mL) in all patients. No postoperative complications occurred. The median postoperative hospital stay was 7 days (interquartile range, 5-7 days).

LIMITATIONS

The sample size was small.

CONCLUSIONS

Our results show that single-access laparoscopic colectomy in the lateral decubitus position is safe and feasible.