Cannula Positioning

Laparoscopic Transverse Colectomy

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

Gastrocolic Ligament

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...

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-...