A technique for laparoscopic-assisted colectomy using two ports

Abstract

Objectives: Laparoscopic colon and rectal surgery requires advanced laparoscopic skills. The aim of this study was to describe a novel technique for laparoscopic-assisted colectomy using only 2 ports and to review our initial experience with this technique for patients with benign colonic pathologies.

Methods: A retrospective chart review of all patients who had laparoscopic-assisted colon surgery using this technique was performed. The technique is described.

Results: For right colectomy, a 10-mm trocar for the camera was placed just below the umbilicus and a 5-mm working port just above the umbilicus. The colon was mobilized using one instrument and gravity assistance. The incisions were then connected, and the mobilized colon was pulled through this incision. For left-sided colectomy, the 5-mm working port was placed at the left suprapubic hairline, which was then extended for removal of the specimen. Sixty patients with benign colonic pathologies had laparoscopic-assisted colon surgery using only 2 ports. Conversion to open surgery was required in 4 cases. The average length of the skin incision was 3.82 cm, and the mean length of hospital stay was 4.18 days. Postoperative complications occurred in 11 patients (18%) and included anastomotic leak in 1 patient and wound infection in 2.

Conclusions: Laparoscopic-assisted segmental colectomy using 2 ports is easy and feasible, with minimal skin incisions and fast recovery. Our initial experience suggests that it may be easier for the experienced colorectal surgeon to acquire the skills needed to perform this technique.

Figure 1.

Trocar placement for laparoscopically assisted right colectomy. The 2 skin incisions are made just above and just below the umbilicus. Arrows pointing to the skin incisions.

Figure 2.

Laparoscopic mobilization of the lateral peritoneal reflection. Tilt to the patient's left side assists in medial mobilization of the colon.

Figure 3.

Trocar placement for laparoscopically assisted left colectomy. The skin incisions are made just below the umbilicus and at the left lower quadrant above the pubic hairline.