Reduced-port laparoscopic restorative proctocolectomy without diverting ileostomy

Area of Science:

• Gastrointestinal Surgery
• Minimally Invasive Procedures
• Colorectal Surgery

Background:

• Familial adenomatous polyposis (FAP) and ulcerative colitis (UC) often require proctocolectomy.
• Traditional proctocolectomy may involve a diverting ileostomy, impacting patient recovery and cosmesis.
• Reduced-port surgery offers potential benefits in minimally invasive colorectal procedures.

Purpose of the Study:

• To introduce and evaluate a novel reduced-port laparoscopic technique for restorative proctocolectomy.
• To assess the feasibility of performing this procedure without a diverting ileostomy.
• To determine the cosmetic outcomes in patients undergoing this modified surgical approach.

Main Methods:

• A multichannel port system was utilized, with additional small ports for instrumentation.
• Intracorporeal proctocolectomy was performed, with specimen extraction through the umbilical incision.
• Extracorporeal ileal J-pouch creation and ileal pouch-anal anastomosis (IPAA) were performed, either intracorporeally or transanally.

Main Results:

• The reduced-port laparoscopic restorative proctocolectomy without diverting ileostomy was successfully performed in three patients (two women, one man).
• All patients experienced uneventful postoperative recovery.
• The procedure demonstrated feasibility and positive cosmetic outcomes.

Conclusions:

• Reduced-port laparoscopic restorative proctocolectomy without a diverting stoma is a feasible surgical option.
• This technique provides excellent cosmetic results in carefully selected patients.
• Further investigation may be warranted to expand the application of this approach.