78 Steps Health Journal

Patient Positioning and Operating Room Setup

After induction of general anesthesia, an orogastric tube and Foley catheter are inserted. The patient is placed in a modified lithotomy position using adjustable stirrups, with both arms tucked at the sides. Venous compression stockings are used in all cases. The patient is placed in Trendelenburg position (20°head-down tilt), and a handassist port is placed in the suprapubic position. For the first phase of the operation (right colon mobilization), the surgeon and first assistant stand on the patient's left side, and the second assistant stands between the legs (Figure 9.2.1A). This position is maintained for the second phase of the operation, or the transverse colon mobilization.

Then, for the third portion of the operation (descending and sigmoid colon mobilization), the surgeon and the first assistant move to the right side of the patient. The second assistant stands between the legs of the patient, only helping as needed (Figure 9.2.1B). For the splenic flexure takedown, the surgeon stands between the legs, with the first and second assistants on the right side of the patient (Figure 9.2.1C).

Figure 9.2.1. A Position of the equipment and the surgical team for the HAL total abdominal colectomy during the first and second phases of the procedure.

Figure 9.2.1. C Position of the equipment and the surgical team for the HAL total abdominal colectomy during splenic flexure takedown.

Figure 9.2.1. C Position of the equipment and the surgical team for the HAL total abdominal colectomy during splenic flexure takedown.

Table 9.2.1. Specific instruments recommended for HAL total abdominal colectomy with ileorectal anastomosis

1 Hand-assisted device

1 Dissecting device (i.e., LigaSure VTM or Ultrasonic Shears™ or electrosurgery)

1 Laparoscopic scissors

1 Laparoscopic dissector

2 Laparoscopic graspers 1 Endoscopic stapler

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