Laparoscopic colectomy with ileorectostomy

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.