[Resection of the sigmoid via laparoscopy: an experimental study of its feasibility]

Abstract

The authors describe an experimental laparoscopic sigmoid colon resection performed in the porcine model. The operation begins with the introduction of the laparoscope via an umbilical trocar. Five other trocars are then placed allowing different maneuvers. The sigmoid colon is grasped in order to gain access to its mesenteric vessels which are clipped and divided, carrying out the dissection of the entire sigmoid colon. Two modified Endo-GIA are then fired both cranially and caudally, in order to obtain a closed sigmoid specimen and to maintain patent the lumen of the descending colon and rectum. The sigmoid is removed transanally. A P-CEEA stapler is introduced via the rectum and its detached anvil is put into the lumen of the descending colon. A purse-string is applied and closed around the anvil rod. The P-CEEA is retracted, and the rectal stump closed with another Endo-GIA. After reintroducing the trocar-loaded stapler, the trocar is advanced through the suture line of the rectum and removed via a port. The stapler is then reassembled, fired and extracted through the anus. Taking into account the oncologic criteria, we think that this mini-invasive technique could be applied, after an adequate training period on the animal model, to humans also.