Abstract
Background
Single-incision laparoscopic colectomy is evolving as a safe and feasible approach for the management of various diseases of the colon and rectum. The modality affords completion of “scarless” surgery through a transumbilical incision; however, this approach is associated with several limitations when performing colorectal procedures involving the pelvis. Collinear alignment of the camera and instruments through a single umbilical incision results in restricted visualization, inadequate dissection and mobilization, and the potential for inadvertent injury. We have developed an innovative approach utilizing a Pfannenstiel incision for single-incision access to the pelvis.
Methods
Single-incision laparoscopic colon resection was performed using a single-access device placed through a mini-Pfannenstiel incision.
Results
Three consecutive patients underwent single-incision laparoscopic anterior rectosigmoid resection for recurrent diverticulitis through a 4-cm Pfannenstiel incision. The procedures were performed at 150, 180, and 195 min with an estimated blood loss of 50, 150, and 75 mL, respectively. The resected specimen lengths were 10.5, 20.2, and 15.0 cm, respectively. There were no conversions to multi-port laparoscopic or open surgery. The length of hospital stay was 4 days for patients 1 and 2, and 3 days for patient 3. There were no major complications or readmissions during postoperative follow-up.
Conclusion
Single-incision laparoscopic anterior rectosigmoid resection for diverticulitis can be performed successfully through a Pfannenstiel incision. This approach facilitates direct visualization and access for rectal and pelvic dissection while maintaining adequate exposure to the left colon and splenic flexure during the procedure.
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References
Ross SB, Clark CW, Morton CA, Rosemurgy AS (2010) Access for laparoendoscopic single site surgery. Diagn Ther Endosc. doi:10.1155/2010/943091
Ramos-Valadez DI, Patel CB, Ragupathi M, Pickron TB, Haas EM (2010) Single-incision laparoscopic right hemicolectomy: safety and feasibility in a series of consecutive cases. Surg Endosc. doi:10.1007/s00464-010-1017-y
Boni L, Dionigi G, Cassinotti E et al (2010) Single incision laparoscopic right colectomy. Surg Endosc. doi:10.1007/s00464-010-1100-4
Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016
Choi SI, Lee KY, Park SJ, Lee SH (2010) Single port laparoscopic right hemicolectomy with D3 dissection for advanced colon cancer. World J Gastroenterol 16:275–278
Law WL, Fan JK, Poon JT (2010) Single-incision laparoscopic colectomy: early experience. Dis Colon Rectum 53:284–288
Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826
Rieger NA, Lam FF (2010) Single-incision laparoscopically assisted colectomy using standard laparoscopic instrumentation. Surg Endosc 24:888–890
Wong MT, Ng KH, Ho KS, Eu KW (2010) Single-incision laparoscopic surgery for right hemicolectomy: our initial experience with 10 cases. Tech Coloproctol. doi:10.1007/s10151-010-0596-x
Merchant AM, Lin E (2009) Single-incision laparoscopic right hemicolectomy for a colon mass. Dis Colon Rectum 52:1021–1024
Bucher P, Pugin F, Morel P (2009) Single-port access laparoscopic radical left colectomy in humans. Dis Colon Rectum 52:1797–1801
Bucher P, Pugin F, Morel P (2010) Transumbilical single incision laparoscopic sigmoidectomy for benign disease. Colorectal Dis 12:61–65
Leroy J, Cahill RA, Asakuma M, Dallemagne B, Marescaux J (2009) Single-access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144:173–179
Takemasa I, Sekimoto M, Ikeda M et al (2010) Transumbilical single-incision laparoscopic surgery for sigmoid colon cancer. Surg Endosc. doi:10.1007/s00464-010-0948-7
Uematsu D, Akiyama G, Matsuura M, Hotta K (2010) Single-access laparoscopic colectomy with a novel multiport device in sigmoid colectomy for colon cancer. Dis Colon Rectum 53:496–501
Vestweber B, Alfes A, Haaf F, Vestweber KH (2010) Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease. Surg Endosc. doi:10.1007/s00464-010-1090-2
Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Weiss H (2010) Single incision laparoscopic sigmoid colon resections without visible scar: a novel technique. Colorectal Dis 12:66–70
Grantcharov TP, Rosenberg J (2001) Vertical compared with transverse incisions in abdominal surgery. Eur J Surg 167:260–267
Brown SR, Goodfellow PB (2008) Transverse versus midline incisions for abdominal surgery. Cochrane Database Syst Rev. doi:10.1002/14651858 CD005199
Tisdale BE, Kapoor A, Hussain A, Piercey K, Whelan JP (2007) Intact specimen extraction in laparoscopic nephrectomy procedures: Pfannenstiel versus expanded port site incisions. Urology 69:241–244
Bird VG, Au JK, Sandman Y, De Los Santos R, Ayyathurai R, Shields JM (2009) Comparison of different extraction sites used during laparoscopic radical nephrectomy. J Urol 181:1565–1570
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The authors of this manuscript have no financial relationships to disclose. The authors have full control of all primary data and agree to allow the journal to review their data if requested.
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Ragupathi, M., Ramos-Valadez, D.I., Yaakovian, M.D. et al. Single-incision laparoscopic colectomy: a novel approach through a Pfannenstiel incision. Tech Coloproctol 15, 61–65 (2011). https://doi.org/10.1007/s10151-010-0663-3
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DOI: https://doi.org/10.1007/s10151-010-0663-3