Single-port laparoscopic total colectomy for medically uncontrolled colitis.

Abstract

New-generation multi-instrument ports for laparoscopic surgery now allow abdominal surgery via a single-access small incision. Here, we detail how laparoscopic total colectomy can be safely performed within the constraints of such single site operating. Three patients (2 males and 1 female; mean age, 28.3 y; mean body mass index, 24.1 kg/m) requiring urgent total colectomy with end ileostomy for colitis resistant to medical therapy fully consented to have their operation performed by a single-port laparoscopic approach. The single port was placed at the site marked preoperatively for the end ileostomy. The operation commenced with rectosigmoid transection and proceeded with a close pericolic dissection proximally along the colon to the cecum. The resected colon was withdrawn via the port site and the end ileostomy fashioned within this wound. The operation was safely completed in its entirety without additional abdominal access in each case. Mean operative time was 206 minutes. All patients are well with normal stoma appearance and function at a minimum follow-up of 4 months. Judicious patient selection and considered operative technique allow major resectional colonic surgery to be safely performed solely by a single-port technique. Proof of clinical benefit along with refined instrumentation is required if such surgery is to progress from anecdotal reports to mainstream practice.