Single-Access Laparoscopic Left and Right Hemicolectomy Combined With Extracorporeal Magnetic Retraction

• Published in: Diseases of the colon & rectum Vol. 53; no. 6; pp. 944 - 948
• Main Authors: Uematsu, Dai, Akiyama, Gaku, Magishi, Akiko, Nakamura, Jiro, Hotta, Kinichi
• Format: Journal Article
• Language: English
• Published: Hagerstown, MDc The ASCRS 01.06.2010; Lippincott Williams & Wilkins
• Subjects: Anastomosis, Surgical; Biological and medical sciences; Colectomy - instrumentation; Colectomy - methods; Colonic Neoplasms - surgery; Digestive system. Abdomen; Endoscopy; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy - methods; Length of Stay - statistics & numerical data; Magnetics; Medical sciences; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Treatment Outcome; Hemicolectomy; Single incision; Left; Magnet; Right; Colectomy; Laparoscopy; Incision; Single access; Treatment; Surgery; Magnetic retraction; Gastroenterology; Colon; Endoscopy
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/DCR.0b013e3181d5e2ee

PURPOSE:In single-access laparoscopic colectomy, the number of forceps inserted through the umbilical incision is limited. To compensate for the single-access site, triangulation must be lost or instrument collision must be sustained. Extracorporeal magnetic retraction can overcome this problem. This report describes the use of this new procedure for colon cancer resection. METHODS:All patients had advanced cancer of the descending or the ascending colon. Single access to the abdomen was achieved with a 3.0- to 4.0-cm umbilical incision. Short vascular forceps and 2 rolls of gauze were inserted into the incision and a columnar magnet was placed on the surface of the abdominal wall. A specially made port access device was attached at the incision. The vascular forceps grasping the tissue were retracted by moving the magnet, enabling triangulation in cooperation with a second forceps. The mesocolon was dissected using a medial to lateral approach. The roots of the vascular pedicles were isolated and divided from the superior or the inferior mesenteric artery during lymph node dissection. Extracorporeal anastomosis was performed. RESULTS:There were no intraoperative complications, no need to convert to open surgery, and no need to add a second port. The median total surgical time was 255 (range, 220–315) minutes. Surgical blood loss was slight (range, 1–20 mL) in all patients. No postoperative complications occurred. The postoperative hospital stay was 7 days for each patient. CONCLUSIONS:This procedure can be safely and feasibly performed using extracorporeal magnetic retraction.