After placement of trocars and survey of the abdomen, complete mobilisation of the intraabdominal colon and terminal ileum up to the inferior border of the duodenum is accomplished. The distal ileum and mesenteric vessels are divided intracor-poreally. With the patient in Trendelenburg position, the rectum is circumferentially dissected down to the pelvic floor and transected with an articulate linear stapler at a level confirmed by digital examination.
Fig. 10. Laparoscopic total colectomy: identification of right ureter
Fig. 12. Laparoscopic total colectomy: preparation of left colon (ligature and section of left colic vessels)
The entire specimen is exteriorised through the enlarged inferior low-quadrant incision. Alternatively, mesenteric vessels are divided outside the abdomen, closer to the colon, brought out through a periumbilical or a suprapubic incision. A standard J-pouch is constructed, the head of a circular stapler is secured in the apex of the pouch. The abdominal incision is sutured, and the pneumoperitoneum is reestablished. The pouch is then brought down well oriented to the pelvic floor, the head is connected to the pin of the stapler, which is advanced through the anus and fired. A suction drain is positioned in the pelvic region behind the ileal pouch. A loop ileosto-my is usually created in the enlarged right lower quadrant trocar site. All trocars sites are inspected, and the parietal incisions are sutured.
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