Right Colectomy

Abstract

With the advent of natural orifices translumena endoscopic surgery (NOTES) and single-port/single-incision laparoscopy (SPL/SLS), minimally invasive surgery recently underwent to an impressive evolution, mainly improving the cosmesis and reducing the abdominal wall trauma. A new concept to be less invasive in minimally invasive surgery started to be popular and named reduced port laparoscopic surgery (RPLS). A reduced number of trocars associated to a reduced size of each trocar and instrument chracterizes this new technique.

During conventional multiport laparoscopic colorectal surgery, the specimen has to be retrieved, hence an enlargement of the trocar or a new opening of the abdominal wall is necessary. With NOTES, surgeons started to consider the natural orifices to remove the specimen from the abdomen (vagina/rectum), and with SPL/SLS to minimize the abdominal trauma and to improve the cosmesis.

In this chapter a right colectomy is described using the suprapubic scar as the main access to perform RPLS and also to remove the specimen from the abdomen at the end. This access remains under the bikini line, hence cosmetically acceptable. The procedure is performed using three reusable trocars inserted close each others in the same suprapubic incision, and curved reusable instruments. Each step is represented by specific drawings showing the internal triangulation, which characterizes the conventional multiport laparoscopy, and the external surgeon’s ergonomy.