Reduced Port Sigmoid and Left Colectomy

Abstract

The left hemicolectomy or sigmoid resection is performed for a wide variety of indications, including malignant disease, such as colon and rectosigmoid junction cancer, and benign conditions, such as diverticulitis, Crohn’s disease, or as part of procedures for prolapse. When deciding between the two procedures for oncologic resections, a left hemicolectomy is appropriate for tumors in the distal transverse colon, descending colon, or proximal sigmoid colon, while a sigmoid colectomy is appropriate for proximal and distal sigmoid colon cancers. With the left hemicolectomy, the left branch of the middle colic vessels and the left colic vessels are included with the specimen in addition to the inferior mesenteric artery, while with the sigmoid colectomy, the inferior mesenteric artery and its terminal branches, as indicated, are included. The exact dissection, resection, and method of vascular ligation will differ, depending on the indication for operations, but in all cases, a minimally invasive approach is safe, feasible, and accelerates recovery. In our experience, the sigmoid colectomy is the ideal procedure for a reduced port laparoscopic approach, where one additional 5 mm umbilical port is used in addition to the single incision port, to overcome technical and ergonomic challenges. Per surgeon preference, the single port can be used alone without the additional port, but we present the “SILS + 1” approach for a sigmoid resection here.