Ergonomic port placement in laparoscopic colorectal surgery.

AIM: Port placement in laparoscopic surgery has important ergonomic implications. A manipulation angle (MA) of 60° has been shown to maximize task efficiency. We calculated the MA used during various stages of both right hemicolectomy (RH) and high anterior resection (AR).

METHOD: We compared two methods of port placement for each operation. RH-PP1 included ports in the left iliac fossa and left upper quadrant. RH-PP2 included ports suprapubically and in the left iliac fossa. We calculated the MA of each of these methods in mobilizing both the caecum and hepatic flexure. AR-PP1 included ports in the right iliac fossa and right upper quadrant. AR-PP2 included ports suprapubically and in the right iliac fossa. We calculated the MA of each of these methods in mobilizing the splenic flexure, descending-sigmoid junction and the recto-sigmoid junction.

RESULTS

For RH-PP1, the mean MA for mobilizing the caecum and hepatic flexure was 38° and 52°, respectively. For RH-PP2, the mean MA for mobilising the caecum and hepatic flexure was 58° and 44°, respectively. For AR-PP1, the mean MA for mobilizing the splenic flexure, the descending-sigmoid junction and the recto-sigmoid junction was 77°, 41° and 18°, respectively. For AR-PP2, the mean MA for mobilizing the splenic flexure, the descending-sigmoid junction and the recto-sigmoid junction was 40°, 56° and 34°, respectively.

CONCLUSION

There are no two port placements that will allow for an ideal MA at every stage of mobilization for either right- or left-sided resection.