Single-scar laparoscopic colectomy with intracorporeal attachable and detachable instruments.

Uematsu, Dai; Magishi, Akiko; Sano, Takayuki; Niitsu, Hirokazu

BACKGROUND In single-access laparoscopic colectomy, the number of instruments that can be inserted through the single-access site is limited by instrument collision. To compensate, triangulation is necessary, but the operative field becomes inadequate. To overcome this problem, intracorporeal attachable and detachable instruments can broaden the field of visceral tissue by retracting from at least 2 points. OBJECTIVE We tested this new procedure for colon cancer surgery. DESIGN This is a prospective study. SETTING This study was conducted at a single-center hospital. PATIENTS Ten consecutive patients (3 male and 7 female) with stage II or III colon cancer underwent the procedure. INTERVENTIONS All patients received a 3.0-cm incision at the umbilicus or right iliac fossa. At least 2 clips and a suspending bar were inserted through a 12-mm port in a multiport access device. The clips grasped the mesocolon at different points and were retracted with either an extracorporeal magnet or fine-loop retractors; this broadened the operative field in the mesocolon by at least 2 points. The mesocolon was dissected with a medial to lateral approach. The suspended bar was tied to 2 fine-loop retractors and manipulated to enlarge the operative field in the mesocolon. The roots of the vascular pedicles were isolated and divided during lymph node dissection. After extracting the specimen, an anastomosis was performed. MAIN OUTCOME MEASURES Intra- and postoperative complications due to inadequate access were the primary outcomes measured. RESULTS There were no intraoperative complications and no need for conversions to open surgery or second access ports. The median total surgical time was 182 minutes (range, 122-245). Surgical blood loss was slight (range, 1-20 mL) in all patients. No postoperative complications occurred. The postoperative hospital stay was 5 to 7 days. LIMITATIONS The sample size was small. CONCLUSIONS This study showed that intracorporeal attachable and detachable instruments were safe and feasible for this procedure.