Suprapubic single incision laparoscopic right hemicolectomy with intracorporeal anastomosis
Epublication WebSurg.com, Dec 2012;12(12). URL: http://websurg.com/doi/vd01en3814
Background: Single incision laparoscopy (SIL) has recently sparked considerable interest. The objectives of this technique are to improve cosmetic outcomes and to reduce invasiveness. Until now the umbilicus was the preferred way of entry, but suprapubic access can be an alternative especially for right hemicolectomy. Clinical case: A 50-year-old male, without previous surgical history and a body mass index of 22 kg/m2 underwent colonoscopy due to anemia. A large base polyp was found in the right colon, and biopsy revealed a colic adenocarcinoma. No distant metastasis or lymphadenopathies were found during preoperative work-up. 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). An intracorporeal anastomosis using a linear stapler was performed, the mesenteric defect was closed, and the access site was finally used for specimen extraction. Results: No additional trocars or conversion to open surgery were necessary. Laparoscopic time was 240 minutes and the final incision length was 4.5cm. Pathological data confirmed the presence of a pT1N0 colonic adenocarcinoma, with 22 negative nodes. The postoperative course was uneventful and the patient was discharged on postoperative day 4. Conclusions: 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. 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. Finally, this access can be enlarged for the extraction of the specimen without cosmetic damage.