Jaime E Sanchez, MD, Andrew D Prather, MD, Jorge E Marcet, MD. University of South Florida College of Medicine
This video demonstrates the technique of laparoscopic single incision sigmoidectomy and rectopexy performed in a 25 year old female with a 4 year history of rectal prolapse and chronic constipation. The laparoscopic single incision technique is a unique approach with minimal postoperative pain, high patient satisfaction and an excellent cosmetic result.
The patient was placed in low lithotomy, prepped and she draped in sterile fashion. An umbilical incision was made large enough to a single incision port. Insufflation of the abdominal cavity was done up to 15 cm pressure with CO2. A 5-mm deflectable tipped laparoscope was used. Exploratory laparoscopy revealed a redundant sigmoid colon and a very low cul-de-sac that could be easily prolapsed out of the rectum.
The presacral space was entered and the dissection was carried all the way to the pelvic floor.
The mesentery of the rectum was divided with a laparoscopic sealing instrument. The superior rectal vessels were divided as was the sigmoid mesentery. The mid rectum was then divided with the endoscopicp stapler.
Rectopexy sutures were then placed into the periosteum of the midsacrum and then sutured to the perirectal peritoneal tissue. This was done on either side of the rectum. The single incision port was then removed and a small wound protector placed. The colon was brought out through this umbilical wound. The mesentery of the proximal colon was divided with the laparoscopic sealing instrument.
The bowel was then transected and the anvil of a 28 mm EEA stapler was introduced into the lumen of the bowel and it was secured with a 2-0 purse string suture. The bowel was reintroduced into the peritoneal cavity. The single incision port was reintroduced through the wound protector. Insufflation was reestablished.
A stapled colorectal anastomosis was made with the EEA stapler passed transrectally. The rectopexy sutures were then tied on either side of the rectum and the anastomosis rested for air leaks.
Insufflation was released and the umbilical fascia was closed with a figure of eight suture and skin closed with absorbable, interrupted 4-0 subcuticular sutures.
The patient did very well postoperatively. She was discharged home on postoperative day 6 tolerating a regular diet.
We have demonstrated a unique technique of laparoscopic single incision sigmoidectomy and rectopexy with excellent clinical and cosmetic results as well as high patient satisfaction.
Program Number: V093