Lindsey S Sharp, MD, Peter Ng, MD, Yale Podnos, MD
The video submitted is that of a hybrid SILS approach to right hemicolectomy with intracorporeal anastomosis. There are several advantages to this technique over standard SILS right hemicolectomy.
The case presented is that of a 49 y.o. male found to have a sessile polyp in the ascending colon on routine screening colonoscopy. The polyp was partially removed endoscopically and found to be a villous adenoma with high grade dysplasia. The patient had a BMI of 31 and no previous abdominal surgery.
The video demonstrates the use of the Ethicon Single Site Access system placed at the umbilicus with an additional 5mm port placed at the suprapubic position. A medial to lateral dissection of the mesentery is undertaken and the ileocolic and middle colic vessels are identified. An intracorporeal stapled ileocolic anastomosis is performed via the crotch of the final anastomosis rather than the ends of the stapled bowel. A hand-sewn closure of the common enterotomy is the shown.
The advantages of this hybrid technique include first avoidance of in-line sword fighting with the instruments and return to triangulation of traditional laparoscopy. Suturing is performed without difficulty. Proper orientation of the bowel is maintained without concern for twisting. Additionally, tearing of the mesentery when trying to pull the bowel into the wound for the anastomosis is avoided. The anastomosis is performed in an area of the bowel where the blood supply is not in question when compared to the stapled ends of the colon and ileum, which appear well vascularized, but may not be. We are also able to keep the skin and fascial incisions smaller with this technique, improving cosmesis.
The patient did very well postoperatively. He was placed on an Entereg protocol and had return of bowel function on POD#2. He was tolerating soft diet by POD#2 and was discharged home that afternoon, requiring only acetaminophen for pain control.
Session: Video Channel Day 1
Program Number: V060