C Palanivelu, P Senthilnathan, P Praveen Raj, R Parthasarthi, S Rajapandian, Jai Ganesh. GEM Hospital & Research Centre
Background: Single incision laparoscopy is rapidly gaining acceptance as evidenced by increasing body of reported literature. Single incision anterior resection is indicated mainly in various benign and malignant diseases sigmoid colon and rectum. Recent reports are supportive of use of minimally invasive methods for these procedures.
Technique:
Peritoneal incision made on the medial of the mesosigmoid close to the sacral promontory. Medial to lateral dissection is then carried out, raising the flap of mesosigmoid, preserving the left ureter and ovarian vessels.
Inferior mesenteric vessels divided close to the origin which aids in further mobilization of the mesosigmoid from retroperitoneal structures.
Line of Toldt’s is incised and both the planes are united thereby completely mobilizing sigmoid and descending colon.
Total meso rectal excision is done, starting posteriorly , moving laterally and completing anteriorly upto pelvic floor.
Rectum is circumferentially divided through the anal canal at the dental line and the specimen is delivered per anus.
Proximal division of colon is done about 10cm from the tumor and after ascertaining the vascularity colo anal anastomosis is done using interrupted sutures.
Covering ileostomy is placed in the same skin incision made for trocar placements.
Conclusion
Single incision anterior resection is feasible & safe procedure in lands of experienced laparoscopic surgeon. It is especially attractive to young patients because of cosmesis less post op pain & earlier return to recovery.
Session Number: SS23 – Plenary II
Program Number: V052