case report

Single Port Laparoscopic Resection of Locally Advanced and Obstructed Caecal Cancer

Waheeb Al-Kubati¹*, Scott MacKenzie², Anil Keshava³

¹21st September University Surgery Department, Sana’a, Yemen

2,3Colorectal Surgical Department, Concord Hospital, NSW, Sydney, Australia

*Corresponding author: Ass Prof Waheeb R Al-Kubati, 21st September University Surgery department & Sana’a University Faculty of Medicine. Sana’a, Yemen.

Received Date: 05 April 2023

Accepted Date: 10 April 2023

Published Date: 12 April 2023

Citation: Al-Kubati W, MacKenzie S, Keshava A (2023) Single Port Laparoscopic Resection of Locally Advanced and Obstructed Caecal Cancer. Ann Case Report 8: 1256. DOI:


The feasibility of employing single incision or single port laparoscopic techniques for right colonic resection has recently been reported by a number of units [1-4]. This paper describes the use of single incision laparoscopic approach for the management of a locally advanced and obstructed caecal cancer.

Keywords: SILCS (Single Incision Laparoscopic Colorectal Surgery); Gelport; Laparoscopic; Minimally Invasive Surgery; Single Incision; SILS


A 72 year old male (BR) was admitted as an emergency, having presented with increasing dyspnoea. He was determined to have a lower respiratory tract infection and was treated for an infective exacerbation of COPD. Routine bloods demonstrated a microcytic anaemia of 71g/dl and confirmed iron deficiency. Colonoscopy to investigate the anaemia revealed an annular tumour of the caecum which on biopsy proved to be an adenocarcinoma. Having been assessed as having a very significant operative risk BR was transferred to a specialist colorectal unit for further management. Staging CT confirmed the presence of a locally advanced caecal mass associated with small bowel obstruction (Figure1).


Figure 1: Coronal CT demonstrating locally advanced caecal cancer with obstruction at the level of adherent small bowel loop.

There were no obvious metastases in the liver or lungs, but pulmonary emboli were suspected. CTPA confirmed the presence of multiple Pulmonary Thrombo-Emboli (PTE) in the majority of segmental pulmonary arteries as well as changes of emphysema. After multi-disciplinary review, it was decided that an IVC filter was not required and the PTE would be managed by means of anticoagulation only. Having begun to experience abdominal discomfort associated with increasing abdominal distension and given the small bowel obstruction on CT nasogastric decompression was attempted with limited effect. BR was counselled regarding his very significant operative risk (ASA 4e) and the benefits of a minimally invasive approach to intervention particularly with regard to his respiratory status were outlined. Consent for a Single Incision Laparoscopic Surgical procedure was obtained.


Patient was placed in the modified Lloyd Davies position under general anaesthesia. A Gelport (Applied Medical, Orange County USA) was inserted via a 40mm incision. Pneumoperitoneum was then established via a 12mm port inserted through the Gelport. Four trocars were used in total: 2 x 5mm Pediports (Covidien, Loughlinstown Ireland) and 2 x 10mm ports (Excel, Johnson & Johnson, Cincinatti USA) (Figure 2). The previously described SILCS technique was used [3]. Laparoscopy (30 degree Olympus laparoscope) confirmed the presence of a locally advanced caecal tumour causing small bowel obstruction at the level of a mid ileal loop adherent to the tumour mass. The tumour was also seen to be adherent to the anterolateral abdominal wall in the right iliac fossa.