title: Single-access laparoscopic colectomy utilizing gravity in the lateral decubitus position.
abstract: 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.
  
  
  METHODS
  This was a prospective study.
  
  
  METHODS
  This single-center study was conducted in a hospital.
  
  
  METHODS
  Ten consecutive patients (4 men and 6 women) with stage II or III colon cancer were included.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  The sample size was small.
  
  
  CONCLUSIONS
  Our results show that single-access laparoscopic colectomy in the lateral decubitus position is safe and feasible.
authors.affiliation: Department of Digestive Surgery, Saku Central Hospital, Saku-City, Nagano, Japan. gorontadu1110@circus.ocn.ne.jp
authors.forename: Dai
authors.initials: D
authors.lastname: Uematsu
authors.forename: Gaku
authors.initials: G
authors.lastname: Akiyama
authors.forename: Akiko
authors.initials: A
authors.lastname: Magishi
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Komatsu
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011446:Prospective Studies; D016896:Treatment Outcome