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Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
Laparoscopic Sigmoid Colon Resection: Supine and Lateral
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Laparoscopic Sigmoid Colon Resection: Supine and Lateral

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  • 1. Laparoscopic Sigmoid Colon Resection: Supine and Lateral George Ferzli, MD, FACS Professor of Surgery, SUNY Downstate Health Science Center, Brooklyn, NY
  • 2. How is it done? 1. Lateral approach 2. Anterior approach
  • 3. Patient with Large Ventral Hernia
  • 4. Lateral Patient Position <ul><li>Patient positioned on right side </li></ul><ul><li>Hand rotated in semicircle over sigmoid for trocar placement (more like triangle) </li></ul>
  • 5. Trocar Placement: Lateral Position
  • 6. Lateral Position Splenic Flexture Mobilization
  • 7. Lateral Approach Inferior Mesenteric Artery
  • 8. Lateral Position Lateral trocar cuts sigmoid
  • 9. Repair - Lateral Position If proximal colon can be brought through lateral incision tension-free, the repair will be tension free.
  • 10. End to End Anastomosis
  • 11. Lap. Sigmoidectomy - Lateral Position
  • 12. Lateral Approach <ul><li>Advantages </li></ul><ul><li>Easy mobilization of splenic flexture </li></ul><ul><li>Easier identification of ureter </li></ul><ul><li>Small bowel out of the way in case of ventral hernia </li></ul><ul><li>Disadvantages </li></ul><ul><li>Inability to evaluate liver </li></ul><ul><li>Poor access to adhesions or lesions on the right side of the recto-sigmoid </li></ul><ul><li>In females, ovary may interfere </li></ul>
  • 13.  
  • 14. Anterior Approach <ul><li>Patient supine </li></ul><ul><li>Position hand over sigmoid and rotate in semi-circle to place trocars (3) </li></ul>
  • 15. Trocar Placement: Anterior Position
  • 16. Anterior Position 1 2 Trocar in inguinal crease cuts sigmoid
  • 17. Repair – Anterior Position If proximal colon can be brought through inguinal crease trocar incision, tension free repair will be successful.
  • 18. Anterior Approach
  • 19.  
  • 20. Medial to Lateral LCR From Jan 1999 to Dec 2004, 100 consecutive patients underwent three trocar, M-L segmental laparoscopic colon resection. LCR’s included sigmoid (55%), right (34%), left (6%) and transverse (5%). All conversions to open surgery (3%) occurred during the early learning curve. Early LCR patients experienced greater morbidity (21% vs 12%) and mortality (5% vs 2%). Significant and consistent improvement in the learning curve occurred after 38 LCR’s. Kim J. et al Medial to Lateral Laparoscopic colon resection: a view beyond the learning curve. Surg Endosc , 2006
  • 21. Questions?
  • 22. Laparoscopic Sigmoid Colectomy Ferzli G et al. (2000 – 2001) Unpublished Data Total (n) = 62 pts Lateral (24) Anterior (38) Age 48 (32 - 70) 46 (27 - 86) Sex, M:F 23:1 35:3 Indications: <ul><li>Diverticulitis </li></ul>16 (2 abscess) 20 (4 abscess) <ul><li>Polyp </li></ul>3 6 <ul><li>Carcinoma </li></ul>5 12 Complications 1 hematoma flank, 1 re-op for SBO, 1 leak (cut.drainage) 1 leak (re-op hartman) Hospital Stay 2.2 (2 - 10) 2.4 (2 - 9) OR Time 142 (98 – 216) 147 (110 – 279)
  • 23.  
  • 24.  

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