J Korean Surg Soc.  2011 Feb;80(2):77-83. 10.4174/jkss.2011.80.2.77.

Single Port Laparoscopic Surgery and Transanal Specimen Retrieval for Sigmoid Colon Cancer

• Kim SH
• Lee JI
• Kim HJ
• Kang WK
• Oh ST
• Kim JG
• Lee SC

• KMID: 2117113
• DOI: http://doi.org/10.4174/jkss.2011.80.2.77

Abstract

Transumbilical single-port laparoscopic surgery (SPLS) is a newly emerged and rapidly evolving, minimally invasive treatment method. Transumbilical SPLS produces minimal parietal injury and can achieve cosmetic advantages by reducing additional trocar placement. The in-line or chopstick arrangement of laparoscopic instruments can make the operative procedures somewhat strange and inconvenient at first, but experienced laparoscopic surgeons can achieve the same coverage as conventional laparoscopic surgery with time. Here, we report the first case of transumbilical SPLS anterior resection (SPLS-AR) with transanal retrieval of aspecimen and intracorporeal single stapling anastomosis. The operating time was 270 min. There were no intraoperative or postoperative complications. Transumbilical SPLS resulted in a 1.5-cm wound with early recovery. Transumbilical SPLS-AR with transanal retrieval and intracorporeal anastomosis for sigmoid colon cancer is feasible by experienced laparoscopic colorectal surgeons based on careful evaluation and selection of patients. This operation fulfills both oncological principles and cosmetic demand.

Keyword

Single port laparoscopic surgery (SPLS); Minimally invasive surgery; Colon cancer

MeSH Terms

Colon, Sigmoid
Colonic Neoplasms
Cosmetics
Humans
Laparoscopy
Postoperative Complications
Sigmoid Neoplasms
Surgical Instruments
Surgical Procedures, Operative
Cosmetics

Figure

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  Fig. 1. At colonoscopy, an ulcerofungating moderately differentiated adenocarcinoma measuring 3.5×3.5 cm was seen in the sigmoid colon.

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  Fig. 2. Formation of a single port by combining a wound retractor and a surgical glove.

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  Fig. 3. Intracorporeal procedures: proximal and distal stump ligation (A). Proximal and distal stump cutting (B). Transanal specimen retrieval (C). Purse-string sutures put into the proximal and distal stumps manually (D). And end-to-end anastomosis with an end-to-end anastomosis (EEA) stapler (E).

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  Fig. 4. Transluminal (transanal) traction using PPH (procedure for prolapsed and haemorrhoids) for countertraction during colonic dissection (A) and setting the anal trocar (B).

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  Fig. 5. Anal trocars for transanal specimen retrieval: prototype (A) and revised versions (B) with different diameters and lengths.

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  Fig. 6. Minimal umbilical incision with a JP drain is the only change postoperatively.

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  Fig. 7. Thirty days postoperatively, the umbilical scar is negligible.

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  Fig. 8. After retrieval via the anal trocar, both ends of the specimen are still tied with Nylon tapes (A). After opening of the specimen (B).

Reference

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