Three steps and a join: a simple guide to right- and left-sided medial to lateral laparoscopic colorectal surgery

Abstract

Background: To provide a standardised 'medial to lateral' approach to laparoscopic colorectal surgery.

Methods: Both right- and left- sided laparoscopic colorectal procedures were simplified into three well-defined steps and a join. An instructional video and procedural guide provides the important pearls and pitfalls in performing laparoscopic colorectal surgery.

Results: During a 10-year period (2006-2016) at a single institution, 20 senior colorectal trainee surgeons and 20 general surgery registrars were trained in the 'three steps and a join' technique. Five hundred and sixty-eight laparoscopic anterior resections using this technique were performed. There were 5 (0.9%) leaks. Five hundred and forty-three laparoscopic right-sided resections were performed. There were 3 (0.6%) anastomotic leaks requiring reoperation and loop ileostomy.

Conclusions: This step-by-step instructional video and procedural guide provides a simple and standardised approach which may be incorporated into a training pathway for laparoscopic right- and left-sided colorectal surgery.

Keywords: Colorectal surgery; Laparoscopic anterior resection; Laparoscopic colectomy; Laparoscopic ileocolic resection; Laparoscopic right hemicolectomy; Medial to lateral.