Objective: To determine the technical feasibility and clinical outcomes of laparoscopic anterior resection using combined single-port and endoluminal technique.
Methods: A single port was placed at the umbilicus. Sigmoid colon was retracted using transabdominal sutures. After adequate mobilization, the colon was stapled distal to the lesion using non-cutting endo-stapler, and the rectum was opened distal to the staple line. The transanal endoscopic operation (TEO) device was placed transanally and the anvil of a circular stapler was then delivered via the device into the peritoneal cavity. The anvil was placed intraluminally via a colotomy made proximal to the lesion; following this the colon was transected above the colotomy site. The specimen was next delivered transanally via the TEO device. Finally, the rectum was closed with endo-stapler and intra-corporeal side-to-end colorectal anastomosis was constructed using the circular stapler.
Results: This technique was attempted in an 82 with an ulcerative tumor growth over the sigmoid colon. Single port anterior resection was performed. The operative time was 150 minutes. There was no intra-operative complication. The patient was discharged on post-operative day 6, with a maximum pain score of 2. Histological examination revealed T2N0 moderately differentiated adenocarinoma with 11 lymph nodes harvested.
Conclusion: Laparoscopic anterior resection using this combined single-port and endoluminal technique is feasible for small lesions in the sigmoid colon or upper rectum. The technique avoids multiple trocar incisions and a minilaparotomy for specimen retrieval.
Session: Podium Video Presentation
Program Number: V035