Single-access laparoscopic colectomy utilizing gravity in the lateral decubitus position

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Single-access laparoscopic colectomy faces challenges with instrument collision, often requiring forfeiture of triangulation.
• The lateral decubitus position offers a potential solution by utilizing gravity to overcome these limitations.

Purpose of the Study:

• To determine the feasibility of performing single-access laparoscopic colectomy with patients in the lateral decubitus position.
• To assess if this approach can maintain surgical effectiveness despite limited instrument access.

Main Methods:

• A prospective, single-center study involving ten patients with stage II or III colon cancer.
• Patients were positioned in the lateral decubitus position, with surgery performed via a single 3.0-cm umbilical incision.
• Procedures included lymphadenectomy, colon dissection from a lateral approach, specimen extraction, and anastomosis (extracorporeal or intracorporeal).

Main Results:

• The procedure was feasible, with no intraoperative complications or need for conversion to conventional surgery.
• Median surgical time was 154 minutes, with minimal blood loss (<20 mL) in all patients.
• No postoperative complications were observed, and the median hospital stay was 7 days.

Conclusions:

• Single-access laparoscopic colectomy in the lateral decubitus position is a safe and feasible technique.
• This approach effectively addresses instrument collision issues in laparoscopic colectomy.
• Further research with larger sample sizes is warranted to confirm these findings.