Laparoscopic Intestinal Duplication Cyst Repair - Technique

This video demonstrates an intracorporeal staple resection and anastomosis of an intestinal duplication cyst. 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. Here you see the room set up with the surgeon at the patient's feet. 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. Upon doing this, the intestinal duplication cyst became readily visible. It appeared to be mid Juneal. Using a bowel grasper, the bowel was elevated, exposing the cyst in the mesentery. A hole was then made in the mesentery, the distal portion of the cyst to allow for placement of the stapler to divide the bowel distally. A similar rent was made in the mesentery at the proximal limit of the cyst. 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 bow. 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. With the proximal and distal divisions complete, attention was turned to the mesentery extending to the cyst and the segment of resected bowel. 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. Vessels of this size, this maneuver is extremely efficient, uh, as it allows for rapid, uh. Ceiling and division of the mesentery. Without the repeated uh placement of endoscopic scissors. With the bowel completely separated and divided. The final attachments were then cut. The specimen was then placed above the liver for later retraction. The two ends of the bow were then aligned to allow for a side to side anastomosis. A 3-0 prole 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. Here you can see how the stitch helps line the two ends of the bow. A hoo viral is placed intracoorally 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. One limb of the stapler was placed up. Each limited bow. And then a side to side anastomosis was completed with a single application of the stapler. Here you can see the wide anastomosis that was created. The resultant enterotomy was then closed with a running 40 viral suture. This was a very fast and efficient way of closing. The small enterotomy. The surgeon can follow himself, keeping adequate tension on the. Uh, running suture line to prevent any gaps. Once the end of the suture line was. Completed. The running suture was sewn to the previously placed day suture at the. Proximal portion of the anastomosis. With this completed. A small specimen bag was placed into the abdomen. This was the thumb of a #8 glove. In order to allow for the bowel to fit in this, the cyst was decompressed using cautery and suction. Here you see the specimen placed in the bag and it was then brought out through the left mid quadrant trochar side. Here are the incisions 2 weeks post-op.