Three-trocar laparoscopic sigmoidectomy with transanal extraction for diverticulitis and endometriosis

Despite improved surgical techniques, anastomotic leakage is still a severe complication in colorectal surgery, with increased morbidity and mortality. The leakage reported rate varies from 3% to 19%, and is usually higher than 10%. In this lecture, Prof. Junji Okuda reports his experience, with video demonstration, in performing low anterior resection and provides his recommendations to prevent anastomotic leakage.

The video "Laparoscopic caecal wedge resection combined with intraoperative colonoscopy for flat polyp", authored by J Leroy, Gf Donatelli, J Marescaux, is analyzed by Dr. Mark Whiteford, MD, FACS, FASCRS, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

This video demonstrates a laparoscopic closure of a Hartmann's 6 months after it was done for a perforated diverticular disease. The surgeon gains access to the peritoneal cavity through a port placed under direct vision in the right upper quadrant. The adhesions to the midline scar are taken down. The rectal stump is identified and mobilized proximally. The colostomy is then taken down and an end to end anastomosis is made with the rectum using an EEA stapler.

The video "Three-trocar laparoscopic sigmoidectomy and transanal extraction of the specimen for diverticular sigmoiditis" authored by J. Leroy and J. Marescaux is analysed by Dr. Barry Salky, MD, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

The objective of this video is to demonstrate the laparoscopic management of complicated sigmoiditis. A persisting chronic abscess between the sigmoid loop and the bladder does not represent a contraindication to this minimally invasive approach. The authors outline the different technical points that will allow to resect the rectosigmoid and control the abscessed area as well as the bladder wall.

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.

This video highlights the critical steps in mobilization of the splenic flexure of the colon using the medial approach.

The author carries out the division of the left colic vessels and gains entry to the lesser sac. The tail of the pancreas, mesocolon, stomach, and posterior aspect of splenic flexure provide landmarks.

The author completes the dissection laterally and division of posterior attachment before commencing the freeing of the lateral structures. This provides access to the posterior dissection completed earlier.