‘Incisionless’ Total Abdominal Colectomy and Restorative Proctocolectomy for Ulcerative Colitis

Deborah S Keller, MS, MD1, Juan R Flores-Gonzalez, MD1, Sergio Ibarra, MD1, Eric M Haas, MD2. 1Colorectal Surgical Associates, 2Colorectal Surgical Associates; Houston Methodist Hospital; University of Texas Medical Center at Houston

Introduction: Advancing laparoscopic surgery to single incision has clinical and cosmetic benefits. When a stoma is planned, operating through the stoma site for an "incisionless" procedure pushes minimally invasive surgery to the next level. We present the technique of "incisionless" total abdominal colectomy for Ulcerative Colitis, with subsequent completion restorative proctectomy with ileal pouch anal anastomosis (IPAA), then ileostomy closure. 

Methods: The Single Incision Access Port is placed at the predetermined right iliac fossa stoma site, and 3 trocars are placed through the device for the camera, bowel grasper, and energy device. A total abdominal colectomy is performed using an inferior to superior approach, and an end ileostomy is matured. There are no incisions visible, only the stoma. At the second stage, the stoma is freed and returned to the abdomen, the Single Incision Access Port is placed through the stoma site, and a completion proctectomy with IPAA is performed, followed by a diverting loop ileostomy. The ileostomy is subsequently taken down at the final stage.

Results: The procedure was performed in 25 patients between 2011 and 2015. 92% were elective, and 8% emergent. The mean age was 44.0 years (SD 15.2), and mean BMI 25.7 (SD 5.1).  32% were on preoperative steroids at the first stage. There were no intraoperative conversions. The mean operative time was 186.2 min (SD 57.3). The mean LOS was 4.7 days (SD 3.1).

Conclusions: Incisionless total abdominal colectomy is feasible and results in excellent clinical and cosmetic outcomes for Ulcerative Colitis patients. The subsequent completion proctectomy with IPAA can also be performed through the stoma site, leaving patients with no visible incisions. Further study on postoperative pain and quality of life is warranted to assess the full benefits of this technique.

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