Faculty Bibliography

BACKGROUND:Initially described in 2008, single-incision laparoscopic colectomy has evolved into a safe and feasible surgical approach. Noted advantages include elimination of trocar-site incisions and improved cosmesis. Additional benefits including reduced abdominal wall trauma, diminished pain, and shorter length of hospitalization have been proposed. Following utilization in over 150 colectomies, we present a standardized approach and describe our technique for single-incision laparoscopic sigmoid resection through a single-port access device. TECHNIQUE/METHODS:A 2.5-cm umbilical incision is used for insertion of the single-incision access device. A 30° 5-mm camera with a right-angle light cord adaptor and 2 bowel graspers are inserted through the access device. Exploration and lysis of adhesions are performed before placing the patient in a steep Trendelenburg position with 20° left-sided elevation. Dissection commences in a medial-to-lateral fashion, developing the presacral avascular plane while ensuring nerve preservation. The retroperitoneal plane is established from the sacral promontory to the lateral peritoneal reflection. After identification of the left ureter and isolation of the vascular pedicle, the inferior mesenteric artery is isolated and ligated. The lateral attachments of the left colon and rectosigmoid are then divided, followed by additional pelvic dissection along the presacral avascular plane. The mesentery of the distal resection margin is divided before transection of the corresponding bowel using a stapling device. The bowel is then extracted and resected at the site of the single-incision access device. An intracorporeal primary end-to-end anastomosis is fashioned. CONCLUSION/CONCLUSIONS:We present a dynamic article with video illustrating a standardized medial-to-lateral approach for single-incision laparoscopic sigmoid resection. The technique effectively avoids the use of multiple trocar sites, maintains basic oncologic principles of resection, and affords the benefits of minimally invasive surgery.

BACKGROUND:Colonic perforation during colonoscopy is a rare complication and is usually considered a surgical emergency. Traditionally, such perforations have required laparotomy with repair or resection. Minimally invasive approaches have recently been successfully implemented. We describe our initial experience with a robotic-assisted laparoscopic technique for primary colorrhaphy following colonoscopic perforation. METHODS:An 84 year-old female presented with an acute sigmoid perforation identified during colonoscopy. Laparoscopic exploration revealed a full-thickness tear into the sigmoid mesentery, which was primarily repaired using robotic-assisted technique. RESULTS:The procedure was successfully completed in 135 min with an estimated blood loss of 25 ml. There were no intraoperative complications or need for open conversion. The patient was discharged after 4 days without further hospitalization or secondary surgical intervention. CONCLUSION/CONCLUSIONS:In the presented case, robotic primary colorrhaphy was demonstrated to be a safe and feasible alternative for the management of acute colonoscopic perforation and may warrant consideration in the emergency setting.