Takeshi Naitoh, MD, Shinobu Ohnuma, MD, Hideaki Karasawa, MD, Atsushi Kohyama, MD, Kazuhiro Watanabe, MD, Hideyuki Suzuki, MD, Fuyuhiko Motoi, MD, Takashi Kamei, MD, Takanori Ishida, MD, Michiaki Unno, MD. Dept of Surg, Tohoku University Graduate School of Medicine
During laparoscopic surgery, in order to recognize the 3-D positional relationship of the surgeons instruments and to perform accurate operation, it is necessary to construct a virtual 3-D space in the brain while watching the 2-D images. Furthermore, depending on the angle of the scope, the movement of the instrument projected on the display monitor may differ from the surgeon’s motion. The largest difference occurs when the scope angle and the viewing angle of surgeons are 180 degrees, and this is called “mirror image”, which leads to extraordinary difficulty in performing precise procedures.
Co-axial setting theory is the basic concept of placement of trocars to conquer these difficulties, setting the angle of the scope and viewing direction of surgeons on the same axis.
We apply this port setting theory to most procedures in colorectal cancer surgery. Especially the right colectomy seems to be the most suitable procedure for this setting. We place the first port on the umbilicus, and additional 2 ports each in both lateral sides are placed. The surgeon stands on the left side of a patient, and the telescope is inserted from the left lower quadrant port. Surgeon’s instruments of both hands inserted from the umbilical port and the left upper quadrant port, which conforms to the co-axial setting theory.
With this setting, surgeons are able to obtain the similar images as they look with their own eyes, and they can learn procedures without visual confusion.
Besides, they are able to perform precise lymph nodes dissection around vulnerable mesenteric vein.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94868
Program Number: V111
Presentation Session: Colorectal Videos II
Presentation Type: Video
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