TECHNICAL NOTE Single incision laparoscopic total abdominal colectomy with ileorectal anastomosis for synchronous colon cancer O. Bardakcioglu • S. Ahmed Received: 9 December 2009 / Accepted: 7 May 2010 / Published online: 26 May 2010 Ó Springer-Verlag 2010 Abstract Single incision laparoscopy is currently per- formed mostly for basic laparoscopic procedures involving single abdominal quadrants. The aim of this case report is to show that single incision laparoscopic techniques can be utilized for complex abdominal laparoscopic proce- dures with a large target organ and a working space involving all quadrants of the abdominal cavity. A single incision laparoscopic total abdominal colectomy with an ileorectal anastomosis and intraoperative CO 2 colonos- copy was performed for a patient with synchronous ade- nocarcinoma of the cecum and the sigmoid colon. The patient was discharged home on postoperative day 4 and had no immediate postoperative complications. Single incision laparoscopy is feasible for complex colorectal procedures. Some of the techniques used may be adapted further to achieve colonic resection via a natural orifice in the future. Keywords Single incision Á Single port Á Laparoscopy Á Colectomy Á Colon cancer Á Natural orifice surgery Introduction Single incision laparoscopic surgery has been introduced for partial colectomy [1]. In comparison to the more commonly performed single incision laparoscopic cholecystectomy or appendectomy the need to mobilize, retract and remove a larger specimen increases the technical difficulty for single incision laparoscopic colectomy [2]. The question arises whether current instrumentation for single incision laparo- scopic surgery and operative techniques can be applied to surgery involving all quadrants of the abdomen including manipulation of the entire colon and mobilization of the transverse colon. Materials and methods We report a case of a 64-year-old male with a past medical history of type 2 diabetes mellitus, hypertension and hypercholesterolemia, who underwent colonoscopy for anemia. He was found to have a large tumor filling the entire cecum and a 3-cm sessile polyp in the sig- moid colon. Biopsy revealed well-differentiated adeno- carcinoma of the cecum and synchronous cancer in the sigmoid colon. Surgical steps Step 1: patient preparation The patient was placed in the lithotomy position on a bean bag with both arms tucked to his sides to facilitate retrac- tion of the colon, omentum and small bowel loops by gravity through bed positioning. Step: 2: access to the abdominal cavity A 3-cm longitudinal incision was made at the midpoint between the umbilicus and the symphysis pubis. This entry point was chosen for adequate visualization of all O. Bardakcioglu (&) Á S. Ahmed Section of Colon and Rectal Surgery, Department of Surgery, Saint Louis University, 3635 Vista Ave, Desloge Tower 3rd Floor, Saint Louis, MO 63110, USA e-mail: obardakc@slu.edu 123 Tech Coloproctol (2010) 14:257–261 DOI 10.1007/s10151-010-0589-9