SAGES Case of the Month: Presentation
Submitted by Michael K.W. Li, MD
"Incisionless" laparoscopic colorectal resection
Background: In performing ‘traditional’ laparoscopic colectomy, specimen retrieval necessitates a mini-laparotomy which often is the cause and evil of postoperative pain, wound infection as well as other pain related complications. Herein we describe a new technique of laparoscopic colectomy without abdominal incision, where total laparoscopic transection, anastomosis as well as specimen delivery can be safely achieved with the use of the transanal endoscopic operation (TEO) device set-up.
Methods: Following specimen transection, the rectal stump was opened, and specimen was delivered per anum through the TEO device. The detachable anvil of the circular stapling device was then passed to the peritoneal cavity, and rectum was stapled again. The abdominal surgeons secured the anvil to the proximal colon via a small colotomy which was subsequently closed; intracorporeal anastomosis was finally performed.
Results: Technique was attempted in four patients (male: female 2:2), aged 64 to 78 years (median: 72), with sigmoid carcinoma. The median operating time was of 140 minutes. The median hospital stay was 6 days with the median maximum pain score of 2.
Conclusions: Incisionless laparoscopic colectomy is feasible. The technique is truly minimally invasive, and wound-related complications can be avoided.
