A three-trocar midline approach to laparoscopic-assisted colectomy

Several techniques have been described for the trocar placement in laparoscopic-assisted colectomy (LAC). They share the placement of four or five trocars in different areas of the abdomen. A specimen extraction incision in these techniques generally incorporates only one or two trocar sites, and combined length of these incisions approximates the length of a limited laparotomy incision for open colectomy. In addition, intracorporeal communication between the surgeon and the first assistant, who usually works "against" the camera, is challenging and may actually prolong the procedure. We describe here a three-trocar midline approach to laparoscopic-assisted colectomy that allows incorporation of these trocar sites into a midline laparotomy approximately 3 inches long for "open" bowel resection and anastomosis. As a result, the total length of the abdominal wall incision is smaller and cosmesis is superior, while the relative simplicity of the technique, in comparison to complete laparoscopic colectomy, is emphasized. In this technique, the surgeon is much less dependent on the assistant's laparoscopic skills, allowing the laparoscopic part of the procedure to be performed by one surgeon assisted only by a camera operator.