Single-incision laparoscopic total colectomy using an organ retractor: A case report. (July 2020) - Ishimaru, Kazuhide
Abstract: Introduction: Single-incision laparoscopic surgery (SILS) has benefits, including less postoperative pain, a shorter incision, and improved cosmesis. However, SILS is technically difficult because of the limited movement. An organ retractor is an instrument that has the potential to overcome these limitations. Presentation of case: An 85-year-old woman with hematochezia was referred to our hospital. Emergency endoscopy showed diverticulosis of the entire colon and active bleeding from the ascending colon. Despite endoscopic clipping, the bleeding continued. SILS total colectomy using an organ retractor was performed due to uncontrollable diverticular bleeding. A 3-cm incision was placed in the umbilicus, and three conventional ports were inserted into the single umbilical incision. An organ retractor was used for hepatocolic ligament transection, transection of the ileocolic vessels, and transection of the mesentery of the sigmoid colon. For each transection, the tension was adjusted to provide a good operative view. The patient's postoperative course was uneventful. Conclusion: An organ retractor was effective for SILS total colectomy to maintain an adequate operative view, which enabled safe dissection. Highlights: Total colectomy causes severe damage because of the extensive organ mobilization. SILS has a benefit in terms of faster postoperative recovery. SILS is often challenging because of the limited movement. An organ retractor is effective for overcoming these restrictions.