A Three-Trocar Midline Approach to Laparoscopic-Assisted Colectomy

Abstract

Several techniques have been described for the trocar placement in laparoscopic-assisted colectomy (LAC). They share the placement of four or five trocars in different areas of the abdomen. A specimen extraction incision in these techniques generally incorporates only one or two trocar sites, and combined length of these incisions approximates the length of a limited laparotomy incision for open colectomy. In addition, intracorporeal communication between the surgeon and the first assistant, who usually works "against" the camera, is challenging and may actually prolong the procedure. We describe here a three-trocar midline approach to laparoscopic-assisted colectomy that allows incorporation of these trocar sites into a midline laparotomy approximately 3 inches long for "open" bowel resection and anastomosis. As a result, the total length of the abdominal wall incision is smaller and cosmesis is superior, while the relative simplicity of the technique, in comparison to complete laparoscopic colectomy, is emphasized. In this technique, the surgeon is much less dependent on the assistant's laparoscopic skills, allowing the laparoscopic part of the procedure to be performed by one surgeon assisted only by a camera operator.

Does a laparoscopic approach to total abdominal colectomy and proctocolectomy offer advantages?

“…Reports of these procedures have been published for familial adenomatous polyposis, malignancy, inflammatory bowel disease (IBD), slow transit, and rectal prolapse [2,10,18,23,25,29,30]. Technical feasibility and methodology have been reported by many groups [1,8,9,21,29]. However, there has been some reluctance about their widespread acceptance.…”

Laparoendoscopic single-site surgery (LESS) for ovarian cyst enucleation: report of first 3 cases

“…Natural orifice transluminal endoscopic surgery (NOTES) and novel single port access/laparoendoscopic single-site surgery (SPA/ LESS) techniques have emerged as viable, feasible, and widely applicable minimally invasive procedures (1)(2)(3)(4). In fact, SPA/LESS showed to improve cosmesis and potentially reduce postoperative pain as well as NOTES (5)(6)(7)(8)(9)(10). At present the SPA/LESS approach has been mainly used in urologic and gastroenteric procedures such as nephrectomy, appendectomy, cholecystectomy, and hemicolectomy (11)(12)(13)(14).…”

Laparoscopic Colorectal Cancer Surgery by a Colon Lifting-up Technique That Decreases the Number of Access Ports

“…[27][28][29] For laparoscopic colectomy, in addition to our study, 2 other papers reporting 3-trocar techniques have appeared. 30,31 In this technique, it is advantageous that the surgeon is much less dependent on the assistant's laparoscopic skills 30 ; however, it is disadvantageous that a great deal of experience is required to achieve optimum proficiency. 31 Trocar reduction surgery is difficult because counter traction is hard to obtain.…”