Intracorporeal Stapled Ileocolic Anastomosis with Mechanical Closure of the Enterotomy After Minimally Invasive Right Co
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HOW I DO IT
Intracorporeal Stapled Ileocolic Anastomosis with Mechanical Closure of the Enterotomy After Minimally Invasive Right Colectomy for Cancer: Introduction of a New Technique Rossella Reddavid 1,2 & Aridai Resendiz 1,2 & Maurizio Degiuli 1,2 Received: 16 May 2020 / Accepted: 11 June 2020 # 2020 The Society for Surgery of the Alimentary Tract
Introduction Laparoscopic colectomy for colon cancer is worldwide well consolidated nowadays. Since the 1980s, the use of stapling devices has changed the practice of colorectal surgery particularly for left colectomies and anterior rectal resections. For right colectomies and transverse colon resections, the optimal type of anastomosis is less codified. Many authors have investigated the differences between minimally invasive extra- and intracorporeal anastomosis after right colon resections reporting that intracorporeal anastomosis is associated with a better cosmesis and earlier recovery of postoperative bowel function without significant differences of intraoperative and postoperative complications.1,2 However, intracorporeal anastomosis is a more demanding procedure, particularly as concerns the closure of the enterotomy, as compared with extracorporeal technique.3 For this reason, to date, the majority of surgeons prefer minimally invasive hand-sewn closure of the enterotomy. A new technique of intracorporeal closure of the enterotomy is clearly described below in a step-by-step fashion.
Description of the Technique During laparoscopic approach, the patient is placed in dorsal lithotomy position with the surgeon standing to the patient’s Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04699-z) contains supplementary material, which is available to authorized users. * Maurizio Degiuli [email protected] 1
University of Turin, Turin, Italy
2
Department of Oncology, Surgical Oncology and Digestive Surgery, San Luigi University Hospital, Orbassano, Turin, Italy
left, and 5 ports are consecutively placed. A 10-mm optical port is placed off midline 1 cm caudal to the umbilicus, and further four working ports are placed under direct vision in the left middle (12-mm port) and upper quadrant (5-mm port), in the right upper quadrant (5-mm port) and in the suprapubic position (5-mm port) (Fig. 1a) The patient is placed in Trendelenburg position and in a left-lateral tilt of 30°. A medial to lateral dissection is routinely performed. During robot-assisted approach, the trocars for robotic arms are usually placed on a conventional diagonal line from the pubic symphysis to the left subcostal mid-clavear line (Fig. 1b). Few authors employed a trocar placement on an unconventional horizontal line 3–4 cm above the pubic symphysis, separated by 6–8 cm each other depending on the size of the patient. There are no differences in operative technique between laparoscopic and robotic procedures. After right-colonic resection, an isoperistaltic side-to-side ileocolic stapled anastomosis is performed with the applicat
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