Laparoscopic right colectomy: bottom-to-up approach with intracorporeal anastomosis

Laparoscopic surgery represents a widely accepted option for selected patients with Crohn's disease (CD): a broad spectrum of procedures, from simple to very complex, can be technically performed. In this authoritative lecture, Dr. Barry Salky presents his experience in the treatment of complex Crohn’s disease.

Introduction
We present the case of a 32-year-old female patient with recurrent episodes of diverticulitis. She underwent an elective sigmoidectomy using the new Sonicision™ cordless ultrasonic dissection device.

Methods
Our set-up consisted of a standard three-port technique with one umbilical optical 10mm port with 1x5mm and 1x12mm right iliac fossa (RIF) ports. After initial peritoneoscopy, the sigmoid mesocolon was divided close to the bowel using the new Sonicision™ cordless ultrasonic dissection device. The mesocolic window was continued distally to the rectosigmoid junction and proximally to the descending colon. The lateral attachments were then mobilized. After rectal washout, the rectum was divided and the sigmoid colon extracted transanally. A colotomy was then made above the inflamed area, the anvil of a circular stapler introduced into the colonic lumen and then advanced up to the proximal bowel (with the aid of a bowel grasper sheathed in a flexible plastic tubing). The proximal sigmoid colon was then divided with a linear stapling device, the specimen removed transanally and the rectum closed. The spike of the anvil was then delivered through the proximal colon using the fishing technique. The colorectal anastomosis was then fashioned in the usual technique with a circular stapler. A leak test was performed thereafter.

Results
The procedure was successfully completed. The Sonicision™ cordless ultrasonic dissection device performed similarly to other power sources but without the impedance of additional wires. It allows for ease of use and quick changing of instruments and ports without the potential of snagging the wire.

Conclusion
The Sonicision™ cordless ultrasonic dissection device performed excellently for laparoscopic colorectal surgery. Cordless dissectors and vessel-sealing devices will be an excellent adjunct to minimally invasive surgery of the future.

Diverticulosis of the left colon is an inflammatory benign disease associated with unpleasant morbidity which lead to pneumaturia and repetitive urinary infection. Computed tomography and colonoscopy may suggest the diagnosis but histology confirms it. The differential diagnosis evokes a malignant lesion and so it is mandatory to perform surgery with an oncological plane. This clinical case is that of a young man with a mass, which includes the left colon, the bladder, and the ileocaecal appendix. A ureteral stent was placed to make surgery safer and a sigmoidectomy with an ileocaecal appendectomy is performed.

In this lecture, Dr Walz presents his technique for left colonic flexure mobilization.

The objective of this video is to demonstrate a sigmoid colectomy technique for a diverticular sigmoiditis with a transanal extraction of the resected colonic segment. The goal of this video is to demonstrate the feasibility of this technique by means of only 3 trocars to further reduce parietal damage. The author reveals his tips and tricks for a perfectly standardized minimally invasive operative technique. In addition to colonic extraction, the different stages of mechanical anastomosis are perfectly outlined. This team recommends that this type of intervention should be used for benign pathologies.