Single-incision clipless laparoscopic total colectomy.

Although single incision laparoscopy surgery (SILS) has been applied to various kinds of surgical diseases, there have few reports on total colectomy by SILS. A 3-cm incision was placed in the umbilical fossa, through which a SILS port was placed. And this laparoscopic procedure was started as follows: Firstly, the greater omentum was divided. After the division was extended to both splenic and hepatic sides, each flexure of the colon was taken down. A mesocolon window was created below the descending to horizontal portion of the duodenum. The mesocolon including vessels from the left side of the window to the sigmoid colon was incised by LigaSure without clips. After intestinal transection was performed at the upper side of the rectum with a stapler, ileo-rectal anastomosis was performed by the double stapling technique. Between 2010 and 2012, eight consecutive patients underwent this procedure. The mean operative time was 228.1 (range 205-255) min, the mean operative blood loss was 64.0 (range 0-310) mL, the mean hospitalization after surgery was 10.8 (range 10-12) days, and no postoperative complications were encountered. Single incision clipless laparoscopic total colectomy using our original procedure seems to be feasible and safe.