Single access laparoscopic restorative proctocolectomy: initial experience and feasibility study.
(2012) XXIVth Belgian Week of Gastroenterology 2011 — Location: (Belgium) Ostende (9.February.2012)
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- Authors
Remue, Christophe 
- Abstract
- INTRODUCTION: With the advancements of minimal-invasive surgery, restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) for ulcerative colitis (UC) is increasingly being performed laparoscopically. Through this approach, quality of life preserving principles of the procedure, developed during the laparotomy era, such as inferior mesenteric vessels, autonomic pelvic nerves and Riolan’s arcade preservation as well as mesenteric lengthening, could be maintained. Recently, single access laparoscopic surgery (SALS) has emerged as an evolution of the standard multiport laparoscopic approach offering a “single scar laparoscopic” alternative for RCP-IPAA. AIM: Assess the feasibility of RCP-IPAA through the SALS approach without modifying the basic principles of the procedure. METHODS: Clinical data were prospectively collected during our initial experience of SALS RPC-IPAA. RESULTS: In our colorectal surgery unit, RPC-IPAA has been performed by multiport laparoscopy for more than 10 years. Since the introduction of the SALS approach in August 2011, 24 colorectal procedures have been performed. Out of those, 4 UC patients (3 female, 1 male), with a median age of 22 years (17 – 38) and a median BMI of 20 kg/m (29 – 25) underwent SALS RPC-IPAA by an experienced laparoscopic surgeon. A single-port device (Applied Medical®, Gel Point™) was positioned either peri-ombilically (n=2) or at the site of the temporary ileostomy (n=2). Median incision length was 4 cm (3,5 – 4). All the major principles of RCP-IPAA could be respected. On a subjective scale, intra-operative technical difficulty was perceived as intermediate by the surgeon accustomed to multiport laparoscopy. The colon and rectum were extracted through the SALS site. Pouch-anal anastomosis was hand-sewn and, in 2 patients, a diverting loop ileostomy was created at the SALS port site. There were no intra-operative complications, no conversions or additional ports required. One complication consisting in focal pouch dehiscence required suture reinforcement performed through redo SALS approach with uneventful recovery. There were no hospital readmissions within postoperative day 30. CONCLUSION: No technical modifications were necessary to perform RPC-IPAA through SALS approach. For experienced laparoscopic colorectal surgeons, SALS RPC-IPAA is feasible although technically more demanding than straight multiport laparoscopic RCP-IPAA. At this time, SALS may present cosmetic advantages and less trauma to the abdominal wall compared to the multiport laparoscopic RCP-IPAA. However, a randomized controlled trial is required to point out short and long-term advantages in comparison to multiport laparoscopic RCP-IPAA.
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Citations
Léonard, D., Remue, C., Cotte, E., Stefanescu, I.-M., Vincart, H., & Kartheuser, A. (2012). Single access laparoscopic restorative proctocolectomy: initial experience and feasibility study. Acta Gastro-Enterologica Belgica (Multilingual Edition), 75(1), I16. https://hdl.handle.net/2078.5/99071 (Original work published 2012)