Mariane Camargo, MD, Tracy Hull, MD, Scott R Steele, MD, Conor P Delaney, Hermann Kessler, MD, PhD. Cleveland Clinic Foundation
With the patient placed in the modified lithotomy position, a short midline incision was made below the umbilicus, and gradually the abdominal cavity was entered. A 12mm balloon trocar was implanted as camera trocar, and pneumoperitoneum was established. Three 5mm trocars were implanted in the left lower, left middle, and right middle abdomen and one 12mm trocar in the right lower abdomen. Medial to lateral approach was applied for the dissection of the entire colon. The procedure was started in the right colon, progressing towards the transverse, descending and sigmoid colon. Colonic segments were devascularized and then mobilized using a sealing device for safe dissection and hemostasis during the procedure. Left ureter, left gonadal vessels and both hypogastric nerves were carefully preserved and dissected posteriorly. A short lower midline incision was made above the symphysis and mobilized rectum and colon were protruded in front of the abdomen until the ileum showed up and it was transected using the Endostapler and a 60mm cartridge. The entire small bowel was run down from Treitz towards the ileum to rule out any twisting of the mesentery. Finally, at the premarked spot in the right middle abdomen, the skin was incised circularly and the ileal stump was protruded in front of the abdomen.
The operative time was 205 minutes, estimated blood loss of 20ml, no need for transfusion, 1900ml of intravenous fluids were administered. The patient' stoma started functioning on postoperative day one, and a soft diet was well tolerated. The patient was discharged home on postoperative day two in stable condition. No 30-day postoperative complications occurred.
A laparoscopic total colectomy for ulcerative colitis patients is safe, results in shorter hospital stay and reduction of postoperative infectious complications, and it should be the approach of choice in experient hands.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94516
Program Number: V194
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop