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Introduction: There has been a recent trend toward decreasing surgical invasiveness by minimizing incision size using single incision laparoscopic surgery. The technique and tools for performing this type of surgery are completely different from conventional laparoscopic surgery thus generating a steep learning curve and increased operative time. We have explored the use of microlaparoscopy in colon surgery to minimize the trauma of surgery without the need for learning an entirely new skill set.

Methods: A retrospective review of all microlaparoscopic segmental colectomies performed by a single surgeon over a 28 month period at a teaching hospital was conducted. Microlaparoscopic surgery was defined as the use of 3mm trocars in addition to a 12mm Hasson umbilical incision, which was later widened for specimen extraction. Cases were excluded if the decision to use either a GelPort, or standard laparoscopic instruments was made at the outset of the case.

Results: 38 patients underwent microlaparoscopic colectomy for cancer (n=14), polyps (n =7), diverticulitis (n =14), Crohn’s disease (n=2) and volvulus (n=1). Six patients (16%) required conversion: 2 to limited laparotomy, 3 to a hand assisted approach through an 8cm pfannenstiel incision, and 1 where a 3mm port was upsized to 12mm. Reasons for conversion included: difficult visualization, inadvertent colotomy, excessive visceral fat, adhesions, inadequate reach of 3mm instruments, need for use of a right lower quadrant GIA stapler, and one positive intra-op leak test. In patients who had resection for cancer, average lymph node harvest was 25 (range 14-70 nodes). Patients who were completed with microlaparoscopic technique had an average extraction incision length of 3.8cm (range 3.0-6.5cm) and on average two additional 3mm port sites. Right colon resections had on average a shorter operative time (181 minutes) when compared to left colon resections (253 minutes). Median length of stay was 4 days (range 3-13 days). 5 patients experienced a total of 10 post operative complications. These included CDiff, AFib, CHF, pneumonia, acute renal insufficiency, respiratory failure, DVT, wound infection, GI bleed, recurrence of colovesical fistula, and one anastomotic leak 2 weeks postoperatively that was managed non-operatively. Thirty day mortality rate was 0/38

Conclusion: Microlaparoscopic colectomy is safe and feasible. It offers a minimally invasive technique that reduces incision length while using similar techniques as standard laparoscopic colectomy. Future advances may continue the trend toward reducing instrument size, thus reducing trauma to the patient while preserving a technique that has already taken years to infiltrate common practice for colon surgery.