Hepatic flexture resection skin#
There are some reported advantages to the intracorporeal anastomosis, namely a potentially higher lymph node yield, a smaller skin incision, and the ability to extract the specimen via a Pfannenstiel’s incision, which has lower rates of incisional hernia. The right colon and the variability of vascular anatomy add to the difficulty of the procedure.Įxtracorporeal anastomosis is commonly performed for right hemicolectomy in most centers. The tenets of CME include high vascular ligation at the root of the vessel, dissection along the embryological planes of the colonic mesentery, and adequate margins of bowel from the tumor.Īlthough the technique was initially described and achieved via a laparotomy, laparoscopic CME was also performed, although it was noted to be technically challenging. There are also some indications that it may lead to improved oncological outcomes. Finally, this access can be enlarged for the extraction of the specimen without cosmetic damage.Ĭomplete mesocolic excision (CME) in colon cancer surgery has recently gained popularity as increasing evidence points to improved oncological clearance with superior lymph node yield, bigger tumor clearance margins, and higher quality surgical specimens.
Intracorporeal anastomosis is carried out without traction, and the gravitational effect of the operating table allows to expose the operative field and to maneuver the colon and the small bowel intracorporeally. The postoperative course was uneventful and the patient was discharged on postoperative day 4.Ĭonclusions: Suprapubic SIL is a useful technique for right hemicolectomy because the mesocolic and the mesenteric dissections are performed on the same axis as the access site. Pathological data confirmed the presence of a pT1N0 colonic adenocarcinoma, with 22 negative nodes. Laparoscopic time was 240 minutes and the final incision length was 4.5cm. Results: No additional trocars or conversion to open surgery were necessary. An intracorporeal anastomosis using a linear stapler was performed, the mesenteric defect was closed, and the access site was finally used for specimen extraction. The technique consisted in performing the resection through the suprapubic access, using three reusable ports and reusable curved instruments according to Dapri (Karl Storz Endoskope). No distant metastasis or lymphadenopathies were found during preoperative work-up. A large base polyp was found in the right colon, and biopsy revealed a colic adenocarcinoma. Until now the umbilicus was the preferred way of entry, but suprapubic access can be an alternative especially for right hemicolectomy.Ĭlinical case: A 50-year-old male, without previous surgical history and a body mass index of 22 kg/m2 underwent colonoscopy due to anemia. The objectives of this technique are to improve cosmetic outcomes and to reduce invasiveness. A laparoscopic intracorporeal anastomosis is mandatory and can be performed using a hand-sewn method.īackground: Single incision laparoscopy (SIL) has recently sparked considerable interest. The patient was discharged after 4 days, and at visit consultations, the symptoms were resolved.Ĭonclusion: Single incision laparoscopic splenic flexure resection can be safely performed using a suprapubic access, which enhances cosmetic outcomes, in addition to the advantages of minimally invasive surgery. Results: Laparoscopic time was 165 minutes and time to perform the anastomosis was 60 minutes. The specimen was removed through a single access and final scar appeared to be 4cm.
An intracorporeal end-to-end transverse sigmoid anastomosis was performed using two converging running sutures. After having completely freed the splenic flexure from its attachments, the transverse colon and the left colon were divided using an articulating linear stapler, introduced into the abdomen under a 5mm, 30-degree long scope. The mobilization of the left mesocolon as well as of the transverse mesocolon was performed. DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were used, in addition to a 10mm, 30-degree regular length scope. Video: A right suprapubic incision was performed and allowed for the introduction of three abdominal trocars (11mm, and two 6mm ones). The patient was scheduled for a suprapubic single incision laparoscopic splenic flexure resection. Background: The authors report the case of a 30-year-old woman who consulted for episodes of diverticulitis due to segmental diverticulosis of the splenic flexure.
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