Abstract
Introduction:
Laparoscopic left hemicolectomy (LLH) remains a technically demanding procedure, with challenges amplified in single-incision laparoscopic surgery (SILS) aimed at improving cosmesis and reducing post-operative pain.1–4 Single-incision plus one-port (SILS + 1) LLH with intracorporeal anastomosis has been demonstrated to be feasible; however, it is technically demanding and requires significant skill and experience. 5 We present a technical modification: placing the patient in a right lateral decubitus position utilizes gravitational retraction of the left colon to facilitate the dissection via a lateral approach. The attached video demonstrates the feasibility of this technology.
Materials and Methods:
A 54-year-old woman presented with abdominal pain for 3 months. Colonoscopy showed that the tumor was 38 cm from the anal verge. Pathological biopsy revealed a moderately differentiated adenocarcinoma. PET/CT showed significant wall thickening and intense FDG uptake (SUVmax 34.9) in the descending colon (cT3N0M0). The operation was performed with the patient under general anesthesia in a right lateral decubitus position. A 4-cm periumbilical incision was made, and a multiport device (SURGAID®) was used for the insertion of the laparoscope and the nondominant instrument. An additional 12-mm trocar was placed at the contralateral McBurney’s point for the surgeon’s dominant instrument. During selected minor steps, the laparoscope was switched to the 12-mm trocar to optimize visualization. The dissection began laterally along the membrane bridge line, then entered the left Toldt’s space. The phrenicocolic ligament, gastrocolic ligament, and splenocolic ligament were divided, followed by taking down the splenic flexure. The inferior mesenteric vein, left colic artery, and two sigmoid arteries were ligated and cut. Following resection of the colon with 5-cm distal and 10-cm proximal margins using two linear staplers, the specimen was extracted through the single port. Subsequently, an intracorporeal side-to-side overlap anastomosis was created between the transverse and sigmoid colon. Finally, the enterotomy was closed using a barbed running suture.
Results:
The operation time was 3 h 5 min. The estimated blood loss was 50 mL. The patient was discharged on post-operative day 8. Final pathology confirmed a moderately differentiated adenocarcinoma (pT4aN0M0). All surgical margins were clear.
Conclusions:
In conclusion, SILS + 1 LLH via a lateral approach is a feasible option for selected patients with left-sided colon cancer. However, precise preoperative tumor localization is essential, as this technique is not recommended for distal sigmoid or rectal cancers.
Authors’ Contributions:
A.W. and Y.S.: Concept and design; acquisition, analysis, or interpretation of data; drafting of the article; and critical revision of the article for important intellectual content. A.W. performed supervision and had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.
Funding Information:
There are no financial conflicts of interest to disclose.
Conflict of Interest Disclosures:
The authors declare that they have no conflict of interest.
Ethical Approval:
This study was approved by the Ethics Committee of the General Hospital of the Western Theater Command.
Data Availability Statement:
The data generated and analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request.
Disclosure Statement:
Authors have received and archived patient consent for video recording/publication in advance of the video recording of the procedure.
Video Duration: 8 min 7 sec.
File Size:
296 MB.
Keywords