Single-access laparoscopic left and right hemicolectomy combined with extracorporeal magnetic retraction.

PURPOSE: In single-access laparoscopic colectomy, the number of forceps inserted through the umbilical incision is limited. To compensate for the single-access site, triangulation must be lost or instrument collision must be sustained. Extracorporeal magnetic retraction can overcome this problem. This report describes the use of this new procedure for colon cancer resection.

METHODS

All patients had advanced cancer of the descending or the ascending colon. Single access to the abdomen was achieved with a 3.0- to 4.0-cm umbilical incision. Short vascular forceps and 2 rolls of gauze were inserted into the incision and a columnar magnet was placed on the surface of the abdominal wall. A specially made port access device was attached at the incision. The vascular forceps grasping the tissue were retracted by moving the magnet, enabling triangulation in cooperation with a second forceps. The mesocolon was dissected using a medial to lateral approach. The roots of the vascular pedicles were isolated and divided from the superior or the inferior mesenteric artery during lymph node dissection. Extracorporeal anastomosis was performed.

RESULTS

There were no intraoperative complications, no need to convert to open surgery, and no need to add a second port. The median total surgical time was 255 (range, 220-315) minutes. Surgical blood loss was slight (range, 1-20 mL) in all patients. No postoperative complications occurred. The postoperative hospital stay was 7 days for each patient.

CONCLUSIONS

This procedure can be safely and feasibly performed using extracorporeal magnetic retraction.