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Single-incision laparoscopic sigmoidectomy and rectopexy
General Surgery / Jun 29th, 2016 3:52 am     A+ | a-


Single-incision laparoscopic (SIL) surgery is developing as an extension of multiport laparoscopic minimally invasive procedure. SIL has been attempted in a variety of surgical procedures, most notably cholecustectomy. There are however relatively few reports of SIL procedures in colorectal disease.
 
The adoption and enthusiasm for reduced port surgery likely owes to a number of potential benefits, such as improved cosmesis, reduced pains secondary to fewer incision, decreased requirements forperioperative opioid analgesics, quicker return to work, and shorter length of hospital stay. One should note, however, that there are no data comparing the single-port approaches.
 
Surgical technique
 
With the patient in the low-lithotomic position, the umbilicus should be averted and a 3-cm incision made through the umbilicus down to the fascia and into the abdominal, cavity. The single- access gel point (applied medical, ranchos anta margarita, CA) should be placed.  A 10/12-mm ports. The Olympus (center valley, PA) flexible tip,5-mm laparoscope was unwed. After careful inspection, the sigmoid IMA pedicle down to the distal sigmoid. The presacral space was entered and gently dissected using the ligasure device the site selected in the distal sigmoid was mobilized and the peritoneum was opened on the left side and the presacral dissection was connected the presacral space was developed for mobilization of the rectum.

The lateral rectal stalks risk of constipation with this maneuver. the bowel was divided with an Endo GIA reticulating stapler. The redundant sigmoid then was brought up out of the pelvis. because of redundancy of the sigmoid in these patients, exteriorization at the umbilicus was not at all difficult. The inferior mesenteric vessels were identified, isolated, and divided after carefully ensuring the leftureter was not incorporated.

The bowel was brought out and the automatic pursestring device was used to divide the bowel the distal resection margin was either in the distal sigmoid or the recto sigmoid junction the distal margin was chosen to allow a gentle tension-free anastomosis without mobilizing the left colon. The anvil was secured by the pursestring suture. The stapler was passed transanally and the stapler and anvil were coupled and leak rectropexy was performed using endostitch two tacks or stitches were used for each case. The rectopexy was placed below the level of the anastomosis and brought up to the presacral fascia.
 
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