Laparoscopic Restorative Proctocolectomy

Introduction: Although many studies have demonstrated good results with laparoscopic proctocolectomy in patients with ulcerative colitis (UC), most surgical procedure require al least one additional incision bigger than 5 cm to complete the surgery. The aim of this video is to show a laparoscopic proctocolectomy with ileoanal J pouch with complete intracorporeal dissection using 4 cm right lower quadrant (RLQ) incision.
Method and Procedure: This is a patient with UC who required proctocolectomy with ileoanal J pouch. The dissection was completely performed by laparoscopy.
With the patients in a modified lithotomy position, six 10/12 mm trocars are used. The colon is mobilized in the medial-to-lateral fashion.
Different steps can be identified in this procedure: 1- Right colon dissection ; 2- Transverse mesocolon dissection; 3- Left colon dissection; 4- Resection of omentum ; 5- Protectomy; 6- Pouch construction.
The rectum is dissected with total mesorectal excision technique, and then it is transected with a laparoscopic articular linear stapler.
The right lower quadrant trocar site is enlarged 4 cm to allow for specimen removal.
Resection and pouch construction is performed extracorporeally as in the conventional fashion.
The pouch is then returned to the abdomen and the anastomosis to the anal canal is performed under laparoscopic control.
A diverting loop ileostomy is created through the right lower quadrant port site, completing the procedure.
Results: The operative time was 245 minutes. The hospital stay was 3 days.
Conclusion: A complete laparoscopic proctocolectomy dissection is feasible and safe for surgical treatment of UC.

Session: Podium Presentation

Program Number: V026

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