Laparoscopic Intestinal Duplication Cyst Repair - Technique

A full-term infant with a prenatally diagnosed abdominal cyst underwent ultrasound which confirmed the presence of a duplication cyst.

At 3 weeks of age, the patient underwent laparoscopic exploration.

The surgeon is positioned at the patient's feet for this procedure.

3 ports were used with ports in the right and left mid quadrant used for the manipulation and resection.

The initial maneuver was to elevate the transverse colon in order to run the bowel.

The intestinal duplication cyst appeared to be mid-jejunal.

The left mid quadrant port was upsized to a 5 millimeter port to allow for placement of the endoscopic stapler.

A single load of the stapler was used to divide the bowel both on the proximal and then on the distal end.

This allowed for division of the bowel without any intraabdominal contamination from the bowel contents.

The 3 millimeter vessel sealer was used to seal the mesentery and then it was stripped off the cyst in the bowel without any bleeding or other issues.

For vessels of this size, this maneuver is extremely efficient as it allows for rapid sealing and division of the mesentery without the repeated placement of endoscopic scissors.

A 3-0 Prolene stitch was placed through the anterior abdominal wall and then placed through first the distal limb and then the proximal limb of the bowel to align the two segments for the side to side anastomosis.

A Vicryl suture is placed intracorporeally to align the proximal segments of the two pieces of bowel to facilitate the side to side anastomosis.

Two enterotomies were then made side by side in each limb of the bowel to allow for placement of the 5 millimeter stapler.

A side to side anastomosis was completed with a single application of the stapler.

The resultant enterotomy was then closed with a running 4-0 Vicryl suture.

This was a very fast and efficient way of closing the small enterotomy.

The surgeon can follow himself, keeping adequate tension on the running suture line to prevent any gaps.

A small specimen bag was placed into the abdomen, which was the thumb of a #8 glove.

The cyst was decompressed using cautery and suction to allow the bowel to fit in the specimen bag.

The specimen was brought out through the left mid quadrant trocar site.