Three trocar laparoscopic sigmoidectomy for diffuse diverticulosis with transanal specimen extraction: tips and tricks
Epublication WebSurg.com, Feb 2012;12(02). URL: http://websurg.com/doi/vd01en3546
The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out. Methods The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed. Conclusion The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).