Single-incision Endoscopy-assisted Ileocecal Resection

Abstract

Minimally invasive laparoscopic surgery was widely performed for colectomies. In recent years, as a new approach, the sigmoid colon or rectum is removed through the anus, minimizing the need for skin incisions. However, the resected ileocecal portion or the right side of the colon may be difficult to remove from the anus. Therefore, it usually needs to be removed using a skin incision, which typically restricts the size of the tissue. In these cases, we applied a less-invasive single-incision endoscopy-assisted colectomy to avoid forceps interference and reduce the port size required for the energy device. In this study, we introduce an ideal single-incision technique. We performed surgeries on 3 patients with cecal or proximal ascending colon cancer (1 early and 2 advanced cases). Under general anesthesia, we initially made a right pararectal incision (3 to 5 cm), which was dependent on the tumor size and fixed a GelPort (Applied Medical, Orange County, CA) and inserted 12- and 5-mm trocars. Through the 12-mm trocar, we inserted a gastrointestinal scope for dissecting the ileocecal area from the retroperitoneum using a hook knife, similar to the endoscopic submucosal dissection technique. After mobilization, all other maneuvers were performed by an open method. The mean surgery time was 185 minutes. There were no major complications among the patients. This single-incision endoscopy-assisted dissection needs no additional suction, irrigation, or electrocoagulator and is a realistic and idealistic technique at present. Transvaginal and transanal retrieval methods are still controversial. We believe that this endoscopic technique may be essential for advancement to minimally invasive laparoscopic surgery toward natural orifice transluminal endoscopic surgery.