Patient Positioning and Operating Room Setup

After an epidural catheter is activated and general anesthesia attained, a Foley catheter and a nasogastric tube are inserted. Venous compression devices in the lower extremities are routinely used. The patient is placed in modified low lithotomy position, which allows an assistant to stand between the patient's legs for transanal insertion of a stapling

Low Lithotomy
Figure 10.4.1. Positions of the equipment and the surgical team for laparo-scopic rectopexy.

device when a sigmoid resection is performed. Early epidural activation is advantageous because it affords sympathetic blockade, which preserves intestinal peristalsis, prevents distension, and facilitates small bowel retraction and pelvic visualization. When a rectal resection and anastomosis is planned, the rectum and colon are irrigated with at least 1000 cc of warm saline or water until clear before draping the patient. Some surgeons also use diluted Betadine irrigation to theoretically prevent local septic complications if microscopic spillage occurs during the construction of the anastomosis.

After adequate venous access has been established, both upper extremities are secured at the patient's side, the abdomen is prepped and draped in the usual sterile manner, and the patient is then placed in slight Trendelenburg position. At least two monitors are necessary for laparoscopic rectal dissection, resection, and/or anastomosis and they should be placed at the foot of the table, so that both the surgeon and the assistants can maintain online visualization. Also, suction and electrosurgical devices are placed at the foot of the table (Figure 10.4.1).

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