Modified Marionette Technique for Laparoscopic Colorectal Surgery.
BACKGROUND
Single-port laparoscopic surgery has some technical limitations with respect to control of the forceps inserted through the single-access site, which results in increased internal collisions due to coaxial alignment of the instruments, as well as and decreased range of motion and visualization. To overcome these limitations, we employ a "modified marionette technique" as a way to carry out laparoscopic colorectal surgery. Materials and Surgical Technique: The procedures for the modified marionette technique are performed as follows: An Internal Organ Retractor (IOR)™ and an atraumatic clip designed to firmly grasp tissue, with 1-0 nylon thread, are inserted through a 12-mm trocar and secured in place where adequate visualization and traction for cutting with a radio knife is required. A looped 1-0 nylon thread put through an 18-gauge injection needle is pierced through the abdominal wall, the looped nylon extruded, and the nylon attached to the IOR is pulled out by threading the looped nylon thread. This allows for adequate traction from outside the body through the abdominal wall and appropriate placing adjustments.


CONCLUSIONS
The "modified marionette technique" using IOR introduced here is an easy, economical, effective and safe traction technique for colorectal surgeries. This technique will be a useful tool for performing both reduced port and multiport laparoscopic colorectal surgeries.
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.
Seiichi
S
Shinji
Hayato
H
Kan
Takeshi
T
Yamada
Michihiro
M
Koizumi
Aya
A
Yamagishi
Yasuyuki
Y
Yokoyama
Goro
G
Takahashi
Takuma
T
Iwai
Keisuke
K
Hara
Kohki
K
Takeda
Keiichiro
K
Ohta
Eiji
E
Uchida
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum / Q000601:surgery*; D003082:Colectomy / Q000295:instrumentation / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome