General anesthesia is used, and we place an orogastric tube and a Foley catheter in order to minimize the chances of damaging the stomach or the bladder during cannula insertion. Pneumatic compression stockings are used in all patients. Two video monitors are placed angling toward the patient at shoulder level. Some surgeons recommend performing the procedure with the patient in the supine position but we prefer the modified lithotomy position using padded stirrups. This position allows the surgeon or assistant to stand between the patient's legs, while the other surgeon stands on the left side of the patient (for ileostomy formation) and facilitates complete inspection of the small intestines (Figure 10.2.1). A mirror image of this setup is used for the sigmoid colostomy formation. The hips and knees are gently flexed to an angle no greater than 15°to avoid laparoscopic instruments colliding with the patient's thighs.
Table 10.2.1. Specific instruments recommended for laparoscopic stoma creation
2-4 Cannulae (1 X 12 mm, 1-3 X 5 mm) 2 Laparoscopic graspers
1 Laparoscopic needle holder
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