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Suprapubic single-incision laparoscopic splenic flexure resection with hand-sewn intracorporeal anastomosis
Background: The authors report the case of a 30-year-old woman who consulted for episodes of diverticulitis due to segmental diverticulosis of the splenic flexure. The patient was scheduled for a suprapubic single incision laparoscopic splenic flexure resection.

Video: A right suprapubic incision was performed and allowed for the introduction of three abdominal trocars (11mm, and two 6mm ones). DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were used, in addition to a 10mm, 30-degree regular length scope. The mobilization of the left mesocolon as well as of the transverse mesocolon was performed. After having completely freed the splenic flexure from its attachments, the transverse colon and the left colon were divided using an articulating linear stapler, introduced into the abdomen under a 5mm, 30-degree long scope. An intracorporeal end-to-end transverse sigmoid anastomosis was performed using two converging running sutures. The mesocolic defect was closed. The specimen was removed through a single access and final scar appeared to be 4cm.

Results: Laparoscopic time was 165 minutes and time to perform the anastomosis was 60 minutes. Operative bleeding was 10cc. The patient was discharged after 4 days, and at visit consultations, the symptoms were resolved.

Conclusion: Single incision laparoscopic splenic flexure resection can be safely performed using a suprapubic access, which enhances cosmetic outcomes, in addition to the advantages of minimally invasive surgery. A laparoscopic intracorporeal anastomosis is mandatory and can be performed using a hand-sewn method.
G Dapri, L Cardinali, A Cadenas Febres, GB Cadière
Surgical intervention
2 years ago
1656 views
92 likes
0 comments
07:12
Suprapubic single-incision laparoscopic splenic flexure resection with hand-sewn intracorporeal anastomosis
Background: The authors report the case of a 30-year-old woman who consulted for episodes of diverticulitis due to segmental diverticulosis of the splenic flexure. The patient was scheduled for a suprapubic single incision laparoscopic splenic flexure resection.

Video: A right suprapubic incision was performed and allowed for the introduction of three abdominal trocars (11mm, and two 6mm ones). DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were used, in addition to a 10mm, 30-degree regular length scope. The mobilization of the left mesocolon as well as of the transverse mesocolon was performed. After having completely freed the splenic flexure from its attachments, the transverse colon and the left colon were divided using an articulating linear stapler, introduced into the abdomen under a 5mm, 30-degree long scope. An intracorporeal end-to-end transverse sigmoid anastomosis was performed using two converging running sutures. The mesocolic defect was closed. The specimen was removed through a single access and final scar appeared to be 4cm.

Results: Laparoscopic time was 165 minutes and time to perform the anastomosis was 60 minutes. Operative bleeding was 10cc. The patient was discharged after 4 days, and at visit consultations, the symptoms were resolved.

Conclusion: Single incision laparoscopic splenic flexure resection can be safely performed using a suprapubic access, which enhances cosmetic outcomes, in addition to the advantages of minimally invasive surgery. A laparoscopic intracorporeal anastomosis is mandatory and can be performed using a hand-sewn method.
Three trocar sigmoidectomy for diverticulitis with transanal extraction
The combination of laparoscopy and specimen extraction through a natural orifice has the potential to decrease wound complications and to improve postoperative recovery.
The objective of this film is to demonstrate the possibilities of specimen extraction of a sigmoid diverticulitis transanally with reduction of abdominal openings that may sometimes induce incisional hernias and postoperative pain.
In this case, a laparoscopic three-port technique is performed: one 12mm optical port situated in the umbilicus, and two right iliac fossa ports (one 5mm port placed in the right flank, and a 12mm port in the right iliac fossa for introduction of staplers).
J Leroy, J Marescaux
Surgical intervention
10 years ago
261 views
23 likes
0 comments
09:26
Three trocar sigmoidectomy for diverticulitis with transanal extraction
The combination of laparoscopy and specimen extraction through a natural orifice has the potential to decrease wound complications and to improve postoperative recovery.
The objective of this film is to demonstrate the possibilities of specimen extraction of a sigmoid diverticulitis transanally with reduction of abdominal openings that may sometimes induce incisional hernias and postoperative pain.
In this case, a laparoscopic three-port technique is performed: one 12mm optical port situated in the umbilicus, and two right iliac fossa ports (one 5mm port placed in the right flank, and a 12mm port in the right iliac fossa for introduction of staplers).
Laparoscopic sigmoidectomy for benign diverticular disease
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration.
The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.
J Leroy, A Melani, J Marescaux
Surgical intervention
5 years ago
5956 views
140 likes
0 comments
33:07
Laparoscopic sigmoidectomy for benign diverticular disease
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration.
The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.
Laparoscopic sigmoidectomy for sigmoid diverticulitis in an obese (BMI=39) female patient
This video demonstrates the laparoscopic approach to sigmoid resection following previous attacks of diverticulitis. The medial vascular approach is employed, although in this case the inferior mesenteric artery is preserved. Obesity presents particular problems of reduced space and difficulty in identification of structures because of visceral adiposity. This video is suitable for advanced laparoscopic digestive surgeons.

The authors use the medial vascular approach, preserving the inferior mesenteric artery. The obese patient presents the dual challenge of reduced space and difficulty in identifying structures. The authors gain exposure of the mesosigmoid, and initially incise the peritoneum to divide the vessels, respecting the superior rectal vessels. They divide only the sigmoid vessels to preserve the superior rectal artery and vein.
J Leroy, J Marescaux
Surgical intervention
12 years ago
1339 views
10 likes
0 comments
21:15
Laparoscopic sigmoidectomy for sigmoid diverticulitis in an obese (BMI=39) female patient
This video demonstrates the laparoscopic approach to sigmoid resection following previous attacks of diverticulitis. The medial vascular approach is employed, although in this case the inferior mesenteric artery is preserved. Obesity presents particular problems of reduced space and difficulty in identification of structures because of visceral adiposity. This video is suitable for advanced laparoscopic digestive surgeons.

The authors use the medial vascular approach, preserving the inferior mesenteric artery. The obese patient presents the dual challenge of reduced space and difficulty in identifying structures. The authors gain exposure of the mesosigmoid, and initially incise the peritoneum to divide the vessels, respecting the superior rectal vessels. They divide only the sigmoid vessels to preserve the superior rectal artery and vein.
Laparoscopic sigmoidectomy for sigmoid diverticulitis in an obese (BMI=30) male patient
This is a didactic video demonstrating laparoscopic sigmoidectomy for diverticular disease. A combined medial and lateral approach is employed in the dissection of the sigmoid vessels, preserving the IMA. The use of the LigaSure device greatly facilitates the dissection. This approach is suitable for general and digestive surgeons.

The authors use a medial approach to divide the branches of the sigmoid vessels. In performing the medial resection for cancer, the authors caution to avoid contact with the colon. The approach may involve a combination of medial and lateral techniques. Monopolar shears help carry out the dissection using traction. Freeing the vessels laterally enables visualization of the mesocolon.
J Leroy
Surgical intervention
12 years ago
1012 views
23 likes
0 comments
17:22
Laparoscopic sigmoidectomy for sigmoid diverticulitis in an obese (BMI=30) male patient
This is a didactic video demonstrating laparoscopic sigmoidectomy for diverticular disease. A combined medial and lateral approach is employed in the dissection of the sigmoid vessels, preserving the IMA. The use of the LigaSure device greatly facilitates the dissection. This approach is suitable for general and digestive surgeons.

The authors use a medial approach to divide the branches of the sigmoid vessels. In performing the medial resection for cancer, the authors caution to avoid contact with the colon. The approach may involve a combination of medial and lateral techniques. Monopolar shears help carry out the dissection using traction. Freeing the vessels laterally enables visualization of the mesocolon.