HALS Sigmoidectomy

Technique Description:

• 1) Exploratory laparoscopy
• 2) Placement of hand-port
• 3) Identification of the tumor and resection of adherent bowel segment
• 4) Sigmoidectomy with termino-terminal mechanical stapled anastomosis

Procedure Steps:

• 1) Pneumoperitoneum with Veress needle in left hypocondrium
• 2) Placement of paraumbilical optical trocar, plus 2 5mm working trocars
• 3) Exploratory laparoscopy, without carcinomatosis
• 4) Placement of HandPort in right hypocondrium
• 5) Identification of the tumor with Invasion of jejunal segment
• 6) Transection of invaded bowel segment with linear stapler
• 7) Approach of the IMA and IMV and high ligation
• 8) Liberation of the colon from peritoneal attachments and descent of splenic flexure
• 9) Transection of the colon at the level of the peritoneal reflection
• 10) Exteriorization of the specimen through the port, assessment of vascularity with ICG and transection
• 11) Revision of the bowel segment with resection and anastomosis
• 12) Placement of circular stapler anvil and reduction of the colon to the abdominal cavity
• 13) Termino-terminal circular stapled anastomosis
• 14) Closure of ports and incisions

Learning Points:

• Port placement and HALS technique
• High ligation of IM vessels
• Descent of splenic flexure
• Vascular assessment
• Colorectal anastomosis technique

Case Record:

• 60-year-old male patient
• Follow-up of prostate cancer
• Pre-occlusive T4 ADC of the sigmoid colon with Invasion of the small bowel and suspected peritoneal carcinomatosis.

Clinical History:

• 60-year-old male patient in follow-up for prostate adenocarcinoma
• CT-scan with suspected tumor of the sigmoid colon with Invasion of the small bowel and possible peritoneal carcinomatosis
• Colonoscopy confirming circumferential tumor, 23cm from the anal verge. Biopsy compatible with colonic adenocarcinoma
• Discussed in PC Multidisciplinary Meeting, decided exploratory laparoscopy with resection, if possible. CRS + HIPEC if carcinomatosis confirmed

Other History:

• Prostate adenocarcinoma Gleason 9
• Hypertension
• Past Smoker