Minimal invasive surgery for left colectomy adapted to the COVID‐19 pandemic: laparoscopic intracorporeal resection and anastomosis, a ‘don’t touch the bowel’ technique

Abstract

Aim The COVID‐19 pandemic has forced surgeons to adapt their standard procedures. The modifications introduced are designed to favour minimally invasive surgery. The positive results obtained with intracorporeal resection and anastomosis in the right colon and rectum prompt us to adapt these procedures to the left colon. We describe a ‘don't touch the bowel’ technique and outline the benefits to patients of the use of less surgically aggressive techniques and also to surgeons in terms of the lower emission of aerosols that might transmit the COVID‐19 infection. Methods This was an observational study of intracorporeal resection and anastomosis in left colectomy. We describe the technical details of intracorporeal resection, end‐to‐end stapled anastomosis and extraction of the specimen through mini‐laparotomy in the ideal location. Results We present preliminary results of 17 patients with left‐sided colonic pathologies, 15 neoplasia and two diverticular disease, who underwent four left hemicolectomies, six sigmoidectomies and seven high anterior resections. Median operating time was 186 min (range 120–280). No patient required conversion to extracorporeal laparoscopy or open surgery. Median hospital stay was 4.7 days (range 3–12 days). There was one case of anastomotic leak managed with conservative treatment. Conclusion Intracorporeal resection and end‐to‐end anastomosis with the possibility of extraction of the specimen by a mini‐laparotomy in the ideal location may present benefits and also adapts well to the conditions imposed by the COVID‐19 pandemic. Future comparative studies are needed to demonstrate these benefits with respect to extracorporeal anastomosis.

Robotic left hemicolectomy with intracorporeal anastomosis: Description of the technique and initial results

“…Our rLCS can be performed in any type of left colectomy in an orderly and reproducible manner, in any pathology, obtaining very good results regarding suture‐line failure and postoperative complications. This procedure can also be done by laparoscopy [9] and can be performed by consultants or trainees with expertise in the technique. rLCS derives maximum benefit from the advantages of robotic surgery over laparoscopy (i.e., better visualization and easier reinforcement).…”

“…At our centre, this technique is already being performed in laparoscopic surgery with very good results [9], and other groups have also carried out this anastomosis in laparoscopic and robotic surgery [10‐14]. Since the introduction of robotic surgery at our centre, we have also performed the intracorporeal technique in left colectomies.…”

Laparoscopic and robotic intracorporeal resection and end-to-end anastomosis in left colectomy: a prospective cohort study — stage 2a IDEAL framework for evaluating surgical innovation

“…The main stages of intracorporeal resection and anastomosis in the left colectomy, “a don’t touch the bowel technique,” have been described before [ 12 , 13 ]. These stages apply to both LLC and RLC: Intracorporeal resection (Fig.…”

“…Our team has extensive experience in performing intracorporeal anastomoses in surgery for cancer of the rectum and right colon [ 10 , 11 ]. In the last year, we have applied this experience to the surgery of the left colon, sigmoid, and upper rectum, by performing intracorporeal end-to-end anastomosis without the need for any handling of the specimen [ 12 , 13 ]. In principle, this technique was a surgical adaptation to the situation caused by the COVID-19 pandemic, to follow some of the recommendations like the performance of laparoscopic procedures [ 17 ] with minimal evacuation of gas and exteriorization of the specimen, and intracorporeal intestinal anastomoses, but once its benefits became clear, we incorporated it as a technique under development within the IDEAL framework [ 18 ] and published an initial report describing the technical details and our first series of cases.…”

Minimally Invasive Left Colectomy with Total Intracorporeal Anastomosis versus Extracorporeal Anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation

“…In recent years, various techniques have been described in both laparoscopic and robotic surgery, promising good shortand long-term outcomes. [9][10][11][12][13][14][15][16] However, comparing these IA techniques directly to the standard extracorporeal method is complex. The literature's ndings on functional disparities between various anastomosis types are inconsistent.…”