Single Incision Laparoscopic Colorectal Surgery
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Single Incision Laparoscopic Colorectal Surgery. Dan Geisler, MD, FACS, FASCRS. Disclosures. Covidien Consultant. M.I.C.R.S. Strategy to Combat Time Constraints of Laparoscopic Colorectal Surgery. break operation into directly productive vs. nonproductive actions

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Disclosures
Disclosures

  • Covidien Consultant



Strategy to combat time constraints of laparoscopic colorectal surgery
Strategy to Combat Time Constraints of Laparoscopic Colorectal Surgery

  • break operation into directly productive vs. nonproductive actions

  • standardize approach to improve efficiency

  • retraction performed by gravity

  • keep repositioning to a minimum

3 Trocar Technique


RIGHT COLECTOMY Colorectal Surgery

1

2

3


What Can You Do Better Colorectal Surgery

Dan Geisler MD, John Marks MD, and

Gerald Marks MD

The Lankenau Hospital and Institute for

Medical Research, Wynnewood, PA

*San Giovanni Hospital, Rome, Italy


Why 3 trocars
Why 3 Trocars? Colorectal Surgery

  • Simplified Technique

  • Improves Efficiency

  • Improves Learning Curve

  • Safe


Why 3 trocars1
Why 3 Trocars? Colorectal Surgery

  • Simplified Technique

  • Improves Efficiency

  • Improves Learning Curve

  • Safe

  • SILS!!!


RIGHT COLECTOMY Colorectal Surgery

1

3

2


Preceptorship
Preceptorship Colorectal Surgery

  • > 100 Surgeons

  • 1 Day preceptorship

  • All with advanced laparoscopic skills

  • All completed SILS cases


Sils right colectomy
SILS Right Colectomy Colorectal Surgery

  • Lose two 5mm ports

  • What else?


Sils right colectomy1
SILS Right Colectomy Colorectal Surgery

  • Case-Matched Trial

  • SILS vs. Lx vs. HALS

  • N = 87 (29 each group)

Papaconstantinou & Thomas

Scott & White Clinic

JACS, 2011


Sils right colectomy2
SILS Right Colectomy Colorectal Surgery

  • N = 87 (29)

  • Similar OR Time

  • Equivalent EBL

  • Equivalent Wound Complications

Papaconstantinou & Thomas

Scott & White Clinic

JACS, 2011


Sils right colectomy3
SILS Right Colectomy Colorectal Surgery

  • N = 87 (29)

Papaconstantinou & Thomas

Scott & White Clinic

JACS, 2011


Sils right colectomy4
SILS Right Colectomy Colorectal Surgery

CONCLUSIONS:

  • N = 87

  • Improved patient recovery

  • Decrease in early postoperative pain

  • Shorter LOS

Papaconstantinou & Thomas

Scott & White Clinic

JACS, 2011


Sils colorectal
SILS Colorectal Colorectal Surgery


Sils colorectal1
SILS Colorectal Colorectal Surgery

  • Improved recovery

    • Papaconstantinou & Thomas

  • Improved operative time

    • Marks, Geisler

  • Simplified operation