laparoscopic sigmoid colon resection: supine and lateral
DESCRIPTION
TRANSCRIPT
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Laparoscopic Sigmoid Colon Resection:Supine and Lateral
George Ferzli, MD, FACSProfessor of Surgery, SUNY Downstate Health Science Center, Brooklyn, NY
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How is it done?
1. Lateral approach
2. Anterior approach
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Patient with Large Ventral Hernia
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Lateral Patient Position
• Patient positioned on right side
• Hand rotated in semicircle over sigmoid for trocar placement (more like triangle)
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Trocar Placement: Lateral Position
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Lateral PositionSplenic Flexture Mobilization
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Lateral ApproachInferior Mesenteric Artery
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Lateral Position
Lateral trocar cuts sigmoid
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Repair - Lateral Position
If proximal colon can be brought through lateral incision tension-free, the repair will be tension free.
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End to End Anastomosis
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Lap. Sigmoidectomy - Lateral Position
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Lateral Approach
Advantages• Easy mobilization of
splenic flexture
• Easier identification of ureter
• Small bowel out of the way in case of ventral hernia
Disadvantages• Inability to evaluate liver
• Poor access to adhesions or lesions on the right side of the recto-sigmoid
• In females, ovary may interfere
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QuickTime™ and aVC Coding
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Anterior Approach
• Patient supine
• Position hand over sigmoid and rotate in semi-circle to place trocars (3)
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Trocar Placement: Anterior Position
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Anterior Position
1
2
Trocar in inguinal crease cuts sigmoid
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Repair – Anterior Position
If proximal colon can be brought through inguinal crease trocar incision, tension free repair will be successful.
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Anterior Approach
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QuickTime™ and aVC Coding
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Medial to Lateral LCR
From Jan 1999 to Dec 2004, 100 consecutive patients underwentthree trocar, M-L segmental laparoscopic colon resection.LCR’s included sigmoid (55%), right (34%), left (6%) andtransverse (5%). All conversions to open surgery (3%) occurred during the early learning curve.
Early LCR patients experienced greater morbidity (21% vs 12%)and mortality (5% vs 2%).
Significant and consistent improvement in the learning curve occurred after 38 LCR’s.
Kim J. et al Medial to Lateral Laparoscopic colon resection: a view beyond the learning curve. Surg Endosc, 2006
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Questions?
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Laparoscopic Sigmoid Colectomy
Total (n) = 62 pts Lateral (24) Anterior (38)Age 48 (32 - 70) 46 (27 - 86)
Sex, M:F 23:1 35:3
Indications:
• Diverticulitis 16 (2 abscess) 20 (4 abscess)
• Polyp 3 6
• Carcinoma 5 12
Complications 1 hematoma flank,
1 re-op for SBO,
1 leak (cut.drainage)
1 leak (re-op hartman)
Hospital Stay 2.2 (2 - 10) 2.4 (2 - 9)
OR Time 142 (98 – 216) 147 (110 – 279)
Ferzli G et al. (2000 – 2001) Unpublished Data
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