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Single-Access Laparoscopic Colectomy Utilizing Gravity in the Lateral Decubitus Position

Uematsu, Dai M.D.1; Akiyama, Gaku M.D.1; Magishi, Akiko M.D.1; Komatsu, Hirokazu M.D.1; Sano, Takayuki M.D.2

doi: 10.1097/DCR.0b013e31826eef63
Dynamic Article

BACKGROUND: Only a limited number of instruments can be used in single-access laparoscopic colectomy, and triangulation must be forfeited to avoid instrument collision. We investigated whether this problem could be overcome by performing laparoscopic colectomy by the use of the lateral decubitus position, making full use of gravity.

OBJECTIVE: The aim of this study was to determine whether single-access laparoscopic colectomy could be achieved while maintaining patients in the lateral decubitus position.

DESIGN: This was a prospective study.

SETTING: This single-center study was conducted in a hospital.

PATIENTS: Ten consecutive patients (4 men and 6 women) with stage II or III colon cancer were included.

INTERVENTIONS: Each patient was placed in the lateral decubitus position. Single-port access to the abdomen was provided by a 3.0-cm incision at the umbilicus. The roots of the supplying or draining vessels were isolated and divided for lymphadenectomy. Next, the colon was dissected from a lateral approach, without the help of the assistant. The specimen was extracted from the single-access incision. Extracorporeal or intracorporeal anastomosis was performed.

MAIN OUTCOME MEASURES: The primary outcome measured was the feasibility of single-access laparoscopic colectomy in the lateral decubitus position.

RESULTS: There were no intraoperative complications and no need for conversions to conventional laparoscopic surgery, open surgery, or the supine position. The median total surgical time was 154 minutes (interquartile range, 135–220 minutes). Surgical blood loss was slight (<20 mL) in all patients. No postoperative complications occurred. The median postoperative hospital stay was 7 days (interquartile range, 5–7 days).

LIMITATIONS: The sample size was small.

CONCLUSIONS: Our results show that single-access laparoscopic colectomy in the lateral decubitus position is safe and feasible.

Supplemental Digital Content is available in the text.

1 Department of Digestive Surgery, Saku Central Hospital, Saku-City, Nagano, Japan

2 Department of Digestive Surgery, Saitama Cooperative Hospital, Kawaguchi-City, Saitama, Japan

Financial Disclosure: None reported.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Correspondence: Dai Uematsu, M.D., Department of Colorectal Surgery, Saku Central Hospital, 197 Usuda, Saku-City, Nagano, 384-0301, Japan. E-mail:

© The ASCRS 2012