V12-10: HAND-ASSISTED LAPAROSCOPIC RIGHT COLON MOBILIZATION FOR CONTINENT CUTANEOUS ILEAL CECOCYSTOPLASTY
VideoIntroductions and Objectives
Continent cutaneous ileal cecocystoplasty (CCIC) offers an effective treatment option for patients with a thick-walled neurogenic bladder. To achieve a tension-free ileo-colic anastomosis, the right colon must be mobilized past the hepatic flexure via an extended laparotomy. We introduce hand-assisted laparoscopic right colon mobilization to allow for a tension-free bowel anastomosis through a Pfannenstiel incision.
A 10cm Pfannenstiel incision is used to begin mobilization of the cecum along the line of Toldt. A gel hand port is inserted and pneumoperitoneum is achieved. A 12mm camera port is inserted through the umbilicus under direct vision. A 5mm midline trocar is placed one handbreadth cephalad to the umbilicus. The right colon is grasped through the hand port and is mobilized past the hepatic flexure, using electro-dissection via the 5 mm port. A Kocher maneuver is continued until the inferior vena cava and duodenum are well exposed. The stapled ileo-colic anastomosis, staple-tapering of ileum, and bladder augmentation are performed in the usual open fashion. The stoma is matured through the umbilical port site.
The hand-assisted laparoscopic modification of the CCIC has been performed on 20 patients at our institution with an average operative time of 4 hours. One case was aborted before bowel harvest when it was apparent that severe morbid obesity (body mass index of 60) and tight mesentery would preclude a tension-free anastomosis. There have been no bowel injuries or ileo-colic anastomotic leaks.
CCIC using a hand-assisted laparoscopic mobilization of the right colon allows for a less invasive and more efficient bladder reconstructive procedure. Future research will explore whether there is a difference in hernia rates, wound complications or length of stay. _x000D_ _x000D_ Multiple Choice Question:_x000D_ Q: How far should the right colon be mobilized to ensure a tension-free ileo-colic anastomosis during continent cutaneous ileal cecocystoplasty _x000D_ A) not at all_x000D_ B) to the ileo-colic artery_x000D_ C) to the hepatic flexure _x000D_ D) past the hepatic flexure until the inferior vena cava_x000D_ E) past the gastrocolic ligament _x000D_ Explanation:_x000D_ To allow for a tension-free ileo-colic anastomosis during bladder augmentation surgery it is important mobilize the right colon past the hepatic flexure until the inferior vena cava. This allows for the bowel anastomosis to be done through a pfannenstiel incision without tension and injury to the mesentery.