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

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

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

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?