Practical Method of Reabdominal Access After Specimen Removal Through Alexis Wound Retractor During Laparoscopically Assisted Colorectal Surgery

ARAS EMRE CANDA, ASSISTANT PROFESSOR, BAHA ARSLAN, MD. DOKUZ EYLUL UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF SURGERY, TURKEY

INTRODUCTION: During laparoscopically assisted colorectal surgery continuity of the bowel can be constructed extra or intracorporeally. Here we describe a useful method for re-accessing the abdominal cavity after extracting the specimen without the loss of pneumoperitoneum.

METHOD AND RESULT: After finishing the resection of the bowel we enlarge the umbilical optic trocar site incision to 4-5 cm, insert Alexis wound retractor (Medium, Applied Medical) and extract the specimen. After the removal of the specimen we usually construct intracorporeal anastomosis for sigmoid colectomies and anterior resections. Repneumoperitoneum after the closure of the extended umbilical incision site and insertion of an optical trocar can be a problem for air leak. After extracting the specimen through Alexis wound retractor we used reused GellSeal adaptor (Applied Medical) and a 10 mm standard trocar. As we use GellSeal adaptors more than one patient by re-sterilization insertion of the standard 10 mm troacar resulted in unintentional loss of pneumoperitoneum. We than replaced the standard 10 mm trocar by a reused 10 mm blunt tip trocar (AutoSuture) which has balloon localized distal end of the torcar and a proximal foam sponge/collar assembly to minimize leakage.

CONCLUSION: By described method we comfortably perform the intracorporeal anastomosis without the loss of pneumoperitoneum.