New Method of Mobilization of Omentum and Splenic Flexure in Laparoscopic Sigmoidectomy: with the Transenterix Spider

Junjun Ma, MD, Parul J Shukla, MD FRCS, Raghava S Pavoor, MD, Yuko Tonohira, Jeffrey W Milsom, MD FACS. Division of Colon & Rectal Surgery, New York Presbyterian Hospital & Weill Cornell Medical College

Introduction Mobilization of omentum and splenic flexure during laparoscopic sigmoidectomy remains a technically challenging step. TransEnterix SPIDER device is a new device which is considered to be safe and has been used in single incision laparoscopic cholecystectomy. So far laparoscopic colectomy with SPIDER has not been reported.MethodsWe present a case of a 73 year female with a history of sigmoid colon cancer. The initial part of the procedure for this case is performed as that described for a conventional laparoscopic sigmoidectomy. Once the inferior mesenteric artery and inferior mesenteric vein have been divided, the step of mobilizing the splenic flexure is begun. At this stage, the SPIDER is introduced, which is inserted thru the GelPort in the suprapubic area. With 2 semi-flexible tissue-grasping forceps, adequate retraction of the omental attachments to the transverse colon as well as caudal retraction of the splenic flexure is carried out.ResultsThe operative time was 120 minutes, estimated blood loss around 50 mL. No intraoperative complication was encountered and postoperative course was uneventful. The patient was discharged home on Postoperative Day 5.Conclusion The use of the SPIDER device is a new method for facilitating laparoscopic splenic flexure mobilization. It has the potential to achieve safer as well as easier splenic flexure mobilization by providing better exposure as well as retraction of the splenic flexure and the omental attachments to the transverse colon. Improvements in its design will make it more valuable and it could also be used in single incision laparoscopic surgery.