Colonic delta-shaped anastomosis using linear staplers in laparoscopic colectomy
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Colonic delta‑shaped anastomosis using linear staplers in laparoscopic colectomy J. Y. Tajima1 · S. Nagayama1 · Y. Hiyoshi1 · T. Mukai1 · T. Nagasaki1 · T. Yamaguchi1 · T. Akiyoshi1 · T. Konishi1 · Y. Fukunaga1 Received: 17 July 2020 / Accepted: 3 September 2020 © The Author(s) 2020
Although laparoscopic surgery has been the standard for colon cancer as a minimally invasive procedure, intestinal anastomosis is often performed extracorporeally, because it is simple and safe. For secure extracorporeal anastomosis (EA), however, wider dissection of the intestine is required and this more extensive dissection is often labor-intensive and time-consuming, especially in obese or transverse colon cancer patients. Excessive traction of the intestine in EA can also cause damage to the intestine or unnecessary bleeding. To alleviate these difficulties, intracorporeal anastomosis (IA) is recognized as a promising option for reducing the surgical invasiveness of the procedure and for minimizing organ damage and excessive bleeding, thereby reducing short-term morbidity [1]. For colon cancers, IA is performed using either a functional end-to-end anastomosis (FEEA) or a side-to-side anastomosis (overlap) approach. On the other hand, IA in laparoscopic distal gastrectomy for gastric cancers is commonly performed using a delta-shaped anastomosis in Billroth-I reconstruction (Delta-G), as first reported by Kanaya et al. [2]. In addition, for the reconstruction of the cervical esophagus and digestive tract, an esophageal delta-shaped anastomosis (Delta-E) has been developed as a new method of stapled anastomosis [3]. With the widespread application of the delta-shaped anastomosis using linear staplers in the reconstruction of the upper digestive
J. Y. Tajima and S. Nagayama contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10151-020-02341-3) contains supplementary material, which is available to authorized users. * S. Nagayama [email protected] 1
Department of Gastroenterological Surgery, The Cancer Institute Hospital, 3‑8‑31 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
tract, we applied this secure and reliable approach to intestinal reconstruction following colon resection. This video shows a colonic delta-shaped anastomosis (Delta-C) approach using linear staplers in the right and left hemicolectomy. In the right hemicolectomy, a 12-mm port for the surgeon’s right hand is placed approximately four fingerbreadths cranial to the 5-mm port placed in the left lower abdomen. Two 5-mm ports for the first assistant are placed in the right lower abdomen symmetrically opposite the two ports for the surgeon. The camera port is at the umbilicus and the surgery is performed via these five ports. The surgeon stands on the left side of the patient, the first assistant on the right, and the second assistant (camera operator) stands between the patient’s legs or on the left side depending on the situation. After the oral and anal sides of t
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