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Suprapubic single incision laparoscopic segmental small bowel resection including 3 different intracorporeal anastomoses

G Dapri, MD, PhD, FACS, FASMBS, Hon FPALES, Hon SPCMIN, Hon BSS, Hon CBCD, Hon CBC K Grozdev, MD GB Cadière, MD, PhD
Epublication WebSurg.com, Jun 2015;15(06). URL: http://websurg.com/doi/vd01en4493

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  • 2015-06-15
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Background: Single incision laparoscopy (SIL) can be offered to young ladies presenting with malignant digestive tumors since they can undergo surgery through a suprapubic access, with a final non-visible result because it is under the bikini line. Video: A 40-year-old woman presenting with an unknown anemia was admitted to our department. Preoperative work-up evidenced an adenocarcinoma of the small bowel at 120cm from the pylorus. A suprapubic SIL segmental small bowel resection was proposed to the patient. The procedure was performed with the surgeon standing between the patient’s legs, using three reusable ports placed above the pubic bone. Curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) allowed surgeons to work in good ergonomic conditions, maintaining a low cost for SIL. For the insertion of the linear stapler, a temporary 5mm scope was used and the intestinal continuity was established by a completely intracorporeal manual end-to-end anastomosis. Another option is to perform a completely intracorporeal manual end-to-side anastomosis (especially in case of obstructive tumor) or a linear mechanical side-to-side anastomosis. The mesenteric window was closed. The specimen was extracted suprapubically with a wound protection once the three windows of the ports have been joined together. Results: Laparoscopy took 160 minutes and perioperative bleeding was 20cc. No postoperative complications were noted and the use of minimal pain killers allowed for patient discharge after four days. Pathological findings demonstrated a poorly differentiated adenocarcinoma of the jejunum, with 17 negative nodes (pT3N0Mx). The postoperative follow-up, including blood tests and PET-scan, did not show any recurrence at 12 months. Conclusions: In addition to the known advantages of conventional multiport laparoscopy, the SIL technique allows to offer satisfying oncological results in addition to a non-visible surgical scar, because it is localized under the bikini line. Additionally, abdominal trauma and the final scar length can be reduced, since they are related to the tumor’s size.