HALS Sigmoidectomy

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