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Manual colorectal anastomosis during suprapubic single incision laparoscopic left hemicolectomy
Background: Single incision laparoscopic left hemicolectomy is a feasible procedure. A suprapubic access allows to offer satisfactory cosmetic results in case of an extended scar due to a large tumor. An intracorporeal circular mechanical anastomosis is the most common type. A manual anastomosis is feasible and allows to control lumen opening, potential bleeding, and overall to overcome the difficulty of transanal stapler insertion in case of high rectal transection.
Video: This video shows two different types of manual colorectal anastomosis, through a right suprapubic access.
1) Double-layer end-to-end
2) Monolayer end-to-end
Results: After an appropriate learning curve, time to perform the manual anastomosis is 40 minutes.
Conclusions: Different colorectal anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire left hemicolectomy, please click here.
G Dapri
Surgical intervention
4 years ago
3890 views
85 likes
0 comments
04:02
Manual colorectal anastomosis during suprapubic single incision laparoscopic left hemicolectomy
Background: Single incision laparoscopic left hemicolectomy is a feasible procedure. A suprapubic access allows to offer satisfactory cosmetic results in case of an extended scar due to a large tumor. An intracorporeal circular mechanical anastomosis is the most common type. A manual anastomosis is feasible and allows to control lumen opening, potential bleeding, and overall to overcome the difficulty of transanal stapler insertion in case of high rectal transection.
Video: This video shows two different types of manual colorectal anastomosis, through a right suprapubic access.
1) Double-layer end-to-end
2) Monolayer end-to-end
Results: After an appropriate learning curve, time to perform the manual anastomosis is 40 minutes.
Conclusions: Different colorectal anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire left hemicolectomy, please click here.
Suprapubic single incision laparoscopic left hemicolectomy (SILLH): an alternative to the umbilical access
Background: Single incision laparoscopy (SIL) has been described for colorectal surgery because it mainly provides an improved cosmetic outcome. A suprapubic access can be considered an alternative to the umbilical site for left hemicolectomy (LH) because the scar remains under the bikini line and can be considered cosmetically acceptable.

Video: A 61-year-old man was admitted to hospital for adenocarcinoma of the sigmoid colon; preoperative work-up did not show the presence of secondary lesions. A suprapubic SILLH was proposed to the patient. The technique consisted in performing the procedure through an initial 3.5cm skin incision, localized suprapubically, with the insertion of 3 reusable trocars vertically in a pararectal axis along with DAPRI curved reusable instruments (Karl Storz Endoskope, Tüttlingen, Germany). The vascular plane was firstly controlled by clips and, after mobilization of the entire left colon, the upper rectum was transected and the specimen was removed using the same access; a conventional circular transanal anastomosis was performed.

Results: Laparoscopic time was 119 minutes, estimated blood loss was 20cc, and the final scar length measured 4.5cm. Pathology confirmed the presence of a colon adenocarcinoma (pT2N0Mx). Postoperative pain was minimal, allowing the patient to be discharged on postoperative day 4.

Conclusions: Suprapubic SILLH offers the option to enlarge the skin incision according to the specimen’s size without any cosmetic damage, because it remains under the bikini line. The dissection plane appears in front of the access and postoperative pain remains minimal.
G Dapri
Surgical intervention
6 years ago
4254 views
30 likes
0 comments
08:07
Suprapubic single incision laparoscopic left hemicolectomy (SILLH): an alternative to the umbilical access
Background: Single incision laparoscopy (SIL) has been described for colorectal surgery because it mainly provides an improved cosmetic outcome. A suprapubic access can be considered an alternative to the umbilical site for left hemicolectomy (LH) because the scar remains under the bikini line and can be considered cosmetically acceptable.

Video: A 61-year-old man was admitted to hospital for adenocarcinoma of the sigmoid colon; preoperative work-up did not show the presence of secondary lesions. A suprapubic SILLH was proposed to the patient. The technique consisted in performing the procedure through an initial 3.5cm skin incision, localized suprapubically, with the insertion of 3 reusable trocars vertically in a pararectal axis along with DAPRI curved reusable instruments (Karl Storz Endoskope, Tüttlingen, Germany). The vascular plane was firstly controlled by clips and, after mobilization of the entire left colon, the upper rectum was transected and the specimen was removed using the same access; a conventional circular transanal anastomosis was performed.

Results: Laparoscopic time was 119 minutes, estimated blood loss was 20cc, and the final scar length measured 4.5cm. Pathology confirmed the presence of a colon adenocarcinoma (pT2N0Mx). Postoperative pain was minimal, allowing the patient to be discharged on postoperative day 4.

Conclusions: Suprapubic SILLH offers the option to enlarge the skin incision according to the specimen’s size without any cosmetic damage, because it remains under the bikini line. The dissection plane appears in front of the access and postoperative pain remains minimal.
Laparoscopic left colectomy with transmesenteric colorectal anastomosis on the mid-transverse colon
The objective of this film is to show the totalization of a left partial colectomy performed one year ago and the possibility of doing a transmesenteric laparoscopic colorectal anastomosis. This patient had undergone a sigmoidectomy for sigmoid diverticulitis with a colorectal anastomosis one year ago. During the postoperative period, the patient had several subocclusive episodes and suffered from pain related to an ischemic stenosis of the lowered colon with no necrosis. The stenosis has become increasingly incapacitating, not only at the level of the anastomosis but especially at the level of the left colon, which has been getting narrower.
J Leroy, J Marescaux
Surgical intervention
9 years ago
1999 views
119 likes
0 comments
12:03
Laparoscopic left colectomy with transmesenteric colorectal anastomosis on the mid-transverse colon
The objective of this film is to show the totalization of a left partial colectomy performed one year ago and the possibility of doing a transmesenteric laparoscopic colorectal anastomosis. This patient had undergone a sigmoidectomy for sigmoid diverticulitis with a colorectal anastomosis one year ago. During the postoperative period, the patient had several subocclusive episodes and suffered from pain related to an ischemic stenosis of the lowered colon with no necrosis. The stenosis has become increasingly incapacitating, not only at the level of the anastomosis but especially at the level of the left colon, which has been getting narrower.