Single Port Access Left Colectomy

Shuji Kitashiro, MD PhD, shunichi okushiba, yo kawarada, yuma ebihara, takeshi sasaki, daisuke miyasaka, hiroyuki katoh. Tonan hospital

Objective
Single incision laparoscopic surgery is a new advance where in laparoscopic surgery is carried out through a single small incision hidden in the umbilicus. Advantages of this technique over standard laparoscopy are still under investigation. The objective of this study is to describe the short term outcomes of single port access(SPATM) colectomy in a single community based institution.
Methods
Following an institutional review board, patients with colorectal disease were recruited from November 2009. During this time, 15 patients underwent SPA.
As opposed conventional laparoscopic colectomy using tree or four access ports, we perform SPATM colectomy using a 30 degree angled laparoscope, endo instruments and endo-clips. A vertical incision is made at an everted umbilicus for an average length of 2.5cm. 3 trocars are inserted through this incision. A clear trocars is centrally placed and two 5mm trocars are then placed in a triangulated fashion. The left colon was mobilized using a medial approach. Then the root of the superior rectal artery and inferior mesenteric vein were divided. The rectum was divided 5 cm distal to the lesion with one firing of an endoscopic stapler. The specimen was extracted through a 2.5-cm transumbilical laparotomy. Anastomosis was performed by double stapling technique using a circular stapler intraabdominally,
Results
This procedure was successfully performed in all 20 patients without additional ports.
Mean operating time was 100 minutes. Mean estimated blood loss was 5 milliliters. Post operative complication was wound infection in one patient.
Conclusion
SPATM appears to be a promising alternative to conventional laparoscopic colectomy with acceptable morbidity and mortality. This operation could be safely performed today with current instrumentation. Further improvements in the instrumentation should improve the outcomes and adoption of this procedure.