Dissection Approaches

Abstract

The purpose of this chapter is to outline the various approaches that can be taken to mobilise each part of the colon and rectum during single-incision laparoscopic surgery (SILS). As SILS is a means by which colorectal resections are performed, rather than a form of surgery in its own right, it is logical that SILS techniques mimic open surgical resection strategies. Therefore, this chapter places emphasis upon lateral-to-medial dissection approaches, which are the favoured approach of the author. In so doing, it is hoped that senior surgeons developing this skill bring their wealth of operative experience quickly into a new SILS practice, thereby shortening their learning curve. Similarly, with the use of a medial-to-lateral approach, residents may more quickly recognise operative views in SILS surgery, increasing the speed at which they become competent in this technique. Medial-to-lateral dissection remains popular in the UK and Europe and is also discussed in detail. Although the steps necessary to complete specific colorectal operations are discussed elsewhere in this book, the major strategies for dissection during colorectal resection are summarised below. The approaches can either be used in isolation according to the surgeon’s preference or in combination when difficult cases are encountered.