Laparoscopic colectomy with ileorectostomy - general and visceral surgery
You have not purchased a license - paywall is active: to the product selection
Inserting the Veress needle and trocar placement
Due to obesity and a periumbilical scar, establish the pneumoperitoneum by inserting the Veress needle subcostally in the left epigastrium. First, by blunt scissor dissection fashion the channel for a 10mm trocar in the right mid-abdomen and insert the trocar. Now, under direct vision insert another 10 mm trocar at the umbilicus and a 5 mm trocar in the right lower quadrant. Through this 5 mm trocar clear the adhesions with the median umbilical ligament as far as the bladder while staying close to the abdominal wall. Then, insert a 12 mm trocar in the suprasymphyseal region of the planned Pfannenstiel incision. Insert another two 5 mm trocars in the left middle abdomen and left epigastrium, in the latter case at the site of the Veress needle.
Dissecting the ileocecal junction
First, mobilize the terminal ileum, cecum, and ascending colon from inferior and laterally while sparing the Gerota fascia.
Note: While dissecting the right hemicolon, the surgeon and first assistant stand to the left of the patient facing the monitor on the patient's right side. From the time of dissecting the left hemicolon (step 7) until the end of the operation, the sides are switched, with a second monitor now positioned on the left side of the patient.
Mobilizing the ascending colon and taking down the hepatic flexure
On the Gerota fascia, fully mobilize the ascending colon with its mesenteric root up to the duodenum and expose the latter completely. Dissect the hepatic flexure laterally and superiorly and divide adhesions to the gallbladder and a double-barrel configuration between the ascending and transverse colon.
Taking down the greater omentum
Dividing the ileocolic vessels
Dividing the right mesocolon
Mobilizing the left hemicolon and dissecting the upper rectum
Taking down the splenic flexure
Transecting the upper rectum
Colonoscopy of the rectal stump and recovering the colon through a Pfannenstiel incision
Transecting the ileum, placing the purse string suture
Anastomosis
Checking the anastomosis, closing the mesenteric window, placing drains and terminating the operation
Single Access
Access to this lecture
for 3 days
€4.99 inclusive VAT

webop-Account Single
full access to all lectures
price per month
for the modul: vascular surgery