Cannula Positioning

Bleeding Control Deviced

The cannulae are placed as shown in Figure 8.7.2. Technique Phase I Transection of the Inferior Mesenteric Artery and Vein, Medial Dissection of the Left Mesocolon, Pelvic Dissection, Left Lateral Mobilization of the Sigmoid Colon, and Transection of the Upper Rectum The procedure begins as in proctosigmoidectomy. The patient is placed in a steep Trendelenburg position and is tilted right side down so the small intestine falls into the right upper quadrant. All small intestinal loops are...

Gastrocolic Trunk Of Henle

The Gastrocolic Trunk Henle

The patient is placed in the modified lithotomy position to allow the surgeon to stand between the patient's legs for one portion of the operation. After establishing the pneumoperitoneum through an umbilical port, an additional four ports are placed in the left and right lower quadrant, left upper abdomen, and suprapubic area. The operating table is tilted into the slight Trendelenburg position with the left side down to move the small intestine toward the left upper quadrant. The omentum and...

The Operating Room Setup

Modified Lithotomy Position Surgery

A clearly defined setup for all laparoscopic colorectal procedures is recommended. Because laparoscopic surgery requires complex equipment, it is advisable to organize the operating room to facilitate each step of the procedure, increase efficiency, and shorten anesthesia time. A laparoscopic surgical procedure should be initiated only if all equipment is functional and has been calibrated immediately before the scheduled operation. There should also always be backup instruments to replace a...

Dissection and Detachment of the Rectosigmoid Colon

Rectosigmoid Arteries

The initial step in this technique is dissection and detachment of the distal sigmoid colon and the rectum. This can be performed from either the lateral side or the medial side of the rectosigmoid Figure 8.5.3 . When the lateral approach is used, the dissection plane can be naturally exposed while the descending colon is being dissected if the operating table is tilted with the right side down. Ureter and gonadal arteries veins are dissected without any damage if Toldt's fusion fascia, con-...