gms | German Medical Science

Introduction: Single-access laparoscopic surgery should offer minimal scarring without compromising surgical outcome. Herein we describe our technique of single port laparoscopic colorectal procedures.

Materials and methods: Between 11-2008 and 09-2011 we performed 170 laparoscopic colorectal procedures (Mean±SD age 66±13years, BMI 26±5kg/m²) out of a total number of 1132 patients undergoing single access surgery for neoplasma or polyps (88) respectively benign indications (82). The entire operation was carried out transumbilically or via the ileostomy position in the French position using three 5 mm trocars or a single port system.

Results: All but eight procedures could be completed without adding an additional trocar, one was converted to open surgery due to adhesions. Severe Adhesions were found in 52 patients, moderate in 66, an intraabdominal residual abscess in three. Anastomosis was completed by means of stapling or suturing (9), 4 patients underwent rectopexy without anasotmosis. Two patients needed an additional stitch to control leakage or bleeding. One patient needed a double J for the right ureter. Operation time lasted (Mean) 140min. Specimen retrieval was carried out trough the port site, transrectal (2) or transvaginal (2). Specimen yielded (Mean) 29cm, harvested lymphnodes were 16 (Mean).

Patients started oral intake and mobilization at the day of surgery. Reoperation had to be done on 9 patients for anastomotic leakage, and four for other reasons (bleeding, ileus, R1 resection). Mild wound infection at the umbilicus occurred in five patients. Patients were discharged on day (Mean±SD) 8±10. In the follow up umbilical hernia occurred in two patients.

Conclusion: The novel technique of laparoscopic single port transumbilical colorectal procedures further reduces the surgical trauma and allows optimal postoperative cosmesis.