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#December 2012
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Suprapubic single incision laparoscopic right hemicolectomy with intracorporeal anastomosis
Background: Single incision laparoscopy (SIL) has recently sparked considerable interest. The objectives of this technique are to improve cosmetic outcomes and to reduce invasiveness. Until now the umbilicus was the preferred way of entry, but suprapubic access can be an alternative especially for right hemicolectomy.

Clinical case: A 50-year-old male, without previous surgical history and a body mass index of 22 kg/m2 underwent colonoscopy due to anemia. A large base polyp was found in the right colon, and biopsy revealed a colic adenocarcinoma. No distant metastasis or lymphadenopathies were found during preoperative work-up. The technique consisted in performing the resection through the suprapubic access, using three reusable ports and reusable curved instruments according to Dapri (Karl Storz Endoskope). An intracorporeal anastomosis using a linear stapler was performed, the mesenteric defect was closed, and the access site was finally used for specimen extraction.

Results: No additional trocars or conversion to open surgery were necessary. Laparoscopic time was 240 minutes and the final incision length was 4.5cm. Pathological data confirmed the presence of a pT1N0 colonic adenocarcinoma, with 22 negative nodes. The postoperative course was uneventful and the patient was discharged on postoperative day 4.

Conclusions: Suprapubic SIL is a useful technique for right hemicolectomy because the mesocolic and the mesenteric dissections are performed on the same axis as the access site. Intracorporeal anastomosis is carried out without traction, and the gravitational effect of the operating table allows to expose the operative field and to maneuver the colon and the small bowel intracorporeally. Finally, this access can be enlarged for the extraction of the specimen without cosmetic damage.
G Dapri
Surgical intervention
5 years ago
4498 views
44 likes
1 comment
07:18
Suprapubic single incision laparoscopic right hemicolectomy with intracorporeal anastomosis
Background: Single incision laparoscopy (SIL) has recently sparked considerable interest. The objectives of this technique are to improve cosmetic outcomes and to reduce invasiveness. Until now the umbilicus was the preferred way of entry, but suprapubic access can be an alternative especially for right hemicolectomy.

Clinical case: A 50-year-old male, without previous surgical history and a body mass index of 22 kg/m2 underwent colonoscopy due to anemia. A large base polyp was found in the right colon, and biopsy revealed a colic adenocarcinoma. No distant metastasis or lymphadenopathies were found during preoperative work-up. The technique consisted in performing the resection through the suprapubic access, using three reusable ports and reusable curved instruments according to Dapri (Karl Storz Endoskope). An intracorporeal anastomosis using a linear stapler was performed, the mesenteric defect was closed, and the access site was finally used for specimen extraction.

Results: No additional trocars or conversion to open surgery were necessary. Laparoscopic time was 240 minutes and the final incision length was 4.5cm. Pathological data confirmed the presence of a pT1N0 colonic adenocarcinoma, with 22 negative nodes. The postoperative course was uneventful and the patient was discharged on postoperative day 4.

Conclusions: Suprapubic SIL is a useful technique for right hemicolectomy because the mesocolic and the mesenteric dissections are performed on the same axis as the access site. Intracorporeal anastomosis is carried out without traction, and the gravitational effect of the operating table allows to expose the operative field and to maneuver the colon and the small bowel intracorporeally. Finally, this access can be enlarged for the extraction of the specimen without cosmetic damage.
Robotic-assisted mini gastric bypass
Amongst bariatric procedures, mini gastric bypass has been described by Rutledge in 2001 with the objective of simplifying the gastric bypass technique (1). Mini gastric bypass only requires one anastomosis instead of 2 and should reduce complications related to the anastomosis at the foot of the loop in a conventional gastric bypass procedure. A few specificities should be pointed out. The gastric pouch is longer and more narrow. The landmark used to start the gastric division corresponds to the area separating the body of the stomach from the antrum at the level of the angulus. The biliary limb is also much longer and should reach 2cm in order to avoid the undiluted biliary fluid effects on the anastomosis. In this intervention, it is crucial to closue Petersen’s defect between the mounted loop and the transverse mesocolon. According to Himpens, this procedure could well reduce the incidence of hypoglycemias that might occur after a gastric bypass. This video outlines the different steps of the intervention. The use of a surgical robot allows to very easily perform a manual gastrojejunostomy.

(1). Rutledge, R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 2001;11:276-80.
M Vix, KH Liu, J Marescaux
Surgical intervention
5 years ago
2065 views
47 likes
1 comment
15:41
Robotic-assisted mini gastric bypass
Amongst bariatric procedures, mini gastric bypass has been described by Rutledge in 2001 with the objective of simplifying the gastric bypass technique (1). Mini gastric bypass only requires one anastomosis instead of 2 and should reduce complications related to the anastomosis at the foot of the loop in a conventional gastric bypass procedure. A few specificities should be pointed out. The gastric pouch is longer and more narrow. The landmark used to start the gastric division corresponds to the area separating the body of the stomach from the antrum at the level of the angulus. The biliary limb is also much longer and should reach 2cm in order to avoid the undiluted biliary fluid effects on the anastomosis. In this intervention, it is crucial to closue Petersen’s defect between the mounted loop and the transverse mesocolon. According to Himpens, this procedure could well reduce the incidence of hypoglycemias that might occur after a gastric bypass. This video outlines the different steps of the intervention. The use of a surgical robot allows to very easily perform a manual gastrojejunostomy.

(1). Rutledge, R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 2001;11:276-80.
How to improve exposure in laparoscopy: organ suspension with the T-Lift™ device
Organ suspension using a T-lift™ device is a simple method to enhance exposure in laparoscopic surgery, providing adequate vision and operating space and allowing the assistant to focus on helping the surgeon, thus reducing operative times, without the need for difficult intra-abdominal needle manipulation as well as the risk of bowel and vascular injury associated with that approach.
Several examples of organ suspension with the T-lift™ are demonstrated in this video, including suspension of the ovaries, sigmoid colon or vagina in simple procedures, as well as in more complex procedures, for instance by holding the anterior rectal wall for bowel resection with transanal specimen extraction.
A Wattiez, J Albornoz, E Faller, M Puga
Surgical intervention
5 years ago
6838 views
466 likes
1 comment
07:12
How to improve exposure in laparoscopy: organ suspension with the T-Lift™ device
Organ suspension using a T-lift™ device is a simple method to enhance exposure in laparoscopic surgery, providing adequate vision and operating space and allowing the assistant to focus on helping the surgeon, thus reducing operative times, without the need for difficult intra-abdominal needle manipulation as well as the risk of bowel and vascular injury associated with that approach.
Several examples of organ suspension with the T-lift™ are demonstrated in this video, including suspension of the ovaries, sigmoid colon or vagina in simple procedures, as well as in more complex procedures, for instance by holding the anterior rectal wall for bowel resection with transanal specimen extraction.