Left colectomy

Current efforts in minimally invasive laparoscopic surgery have led to reduced port laparoscopic surgery (RPLS). The aim is to decrease trauma by reducing the number of ports and/or size of the trocars. Single-site laparoscopic colectomy (SLC) performed entirely through one incision is considered the ultimate RPLS for colectomy because it is thought to improve cosmesis, reduce postoperative pain, and reduce abdominal wall morbidity. Several reports have described the feasibility and benefits of SLC, but there are technical limitations. In addition, oncologic clearance in SLC has not been fully investigated. Laparoscopic left colectomy for a tumor located near the left colic flexure is difficult because the procedure includes extensive dissection in the area of the left colic mesentery with splenic flexure mobilization and appropriate lymphadenectomy corresponding to the individual patient's vessel network. The technical difficulties have delayed standardization of the procedure. Reduced port laparoscopic left colectomy (RPLLC) is an even more difficult procedure. We routinely create a virtual three-dimensional multi-imaging to understand the precise anatomy of the target organs and neighboring structures. Herein, we describe our techniques for RPLLC with D3 lymphadenectomy in detail, including some tips and tricks. Our procedure makes standardization of safe and certain RPLLC possible.