Noelle L Bertelson, MD, Alexandre Bouchard, MD, Tonia Young-Fadok, MD MS. Mayo Clinic Arizona
Introduction: Laparoscopic rectosigmoid resection with rectopexy has become our procedure of choice for rectal prolapse as it minimizes the morbidity of an abdominal procedure for a benign problem. The conventional laparoscopic approach requires an extraction site as well as 3 additional ports in our practice. A single incision procedure further minimizes abdominal wall trauma. We describe here our method of performing single incision laparoscopic rectosigmoid resection and rectopexy.
Method: A 3 cm periumbilical incision is made, and a multiport device is placed. A pneumoperitoneum is established, and the patient is placed in Trendelenberg with the left side up. The lateral attachments of the sigmoid colon are dissected using cautery scissors. This dissection is continued along the left pararectal peritoneum, and the presacral space is entered. The dissection is continued sharply caudally on the left lateral and posterior aspects of the rectum. The right pararectal peritoneum is scored, the presacral space entered, and the dissection joined with that from the left side. The dissection proceeds distally on the right and finally anteriorly, with dissection completed at the level of the pelvic floor. The abdomen is then desufflated, and the rectosigmoid specimen is exteriorized via the multiport incision site. Resection and hand-sewn anastomosis are performed. The specimen is returned to the abdomen, and rectopexy is performed using a spiral tacker to fix the right pararectal tissues to the sacrum.
Results: This patient had a length of stay of 3 days, and the OR time was 135 minutes. Single incision size was 3.1 cm. Maximum pain score at the time of discharge was 4.
Conclusion: Single incision laparoscopic rectosigmoid resection and rectopexy is a procedure that can be safely performed in selected patients while eliminating additional ports and minimizing postoperative complications and pain.
Program Number: V002