Single surgeon surgery: 3 trocar technique for colon resection

Introduction: Laparoscopic colon resection has been demonstrated to be safe and feasible. Despite proven patient benefits, adoption of the technique has been slow. A significant hurdle for adoption has been the technical challenge and need for 1 or 2 (highly) skilled assistants. We present our experience with a single surgeon, 3 trocar technique for colon resection to evaluate its feasibility and safety. Methods: Since 1996 all patients undergoing laparoscopic colon resections have had their data prospectively entered into a database. The database was queried for all patients undergoing colon resection from the beginning of adoption of this technique in 03/99 to 07/07. Data regarding patient demographics, perioperative course, laparoscopic completion rates, early and late morbidity and mortality are reported. Results: 742 laparoscopic colon resections (LCR) were performed. The use of 3 trocar technique became prevalent in 07/00. Prior to that time, 7 of 114 laparoscopic colon resections were done with 3 trocars. After that time, 336 of 628 LCR were done with 3 trocars (54%). Of the 343 patients treated with 3 trocars, 185 were women, average age was 63 years (19-92 y.o.). 186 patients (54%) had BMI >25. Surgeries included left colectomies (62%), right colectomies (33%), APRs (2%), total colectomies (2%) and segmental resection (2%). Indications were cancer (36%), diverticulitis (30%) and polyps (20%). 3% were converted to an open procedure, most commonly due to inflammatory process or tumor involvement. Return of bowel function (flatus) was 2.1 days (1-25 days) and length of stay was 5.9 days (1-27 days). There was one mortality, from a postop MI. Major morbidity rate was 8% with overall morbidity rate of 17%. Anastomotic leaks were 1.5%.
Conclusion: Single surgeon laparoscopic colon resection using a 3 trocar technique is a safe and reliable approach for a variety of pathology. It can be used with good outcome and low conversion rates in various anatomical location and indication. This technique can be performed by only a skilled laparoscopic surgeon and a camera operator and holds promise for rural surgeons or those in single practice interested in adopting laparoscopic colon resection.

Session: Poster

Program Number: P101

View Poster