10 Laparoscopic Total Colectomy
10.1 Operating Room Setup: Position of the Patient
The patient is placed supine in a 20° Trendelenburg position. The surgeon and first assistant are on the right side of the patient. The second assistant stands between the legs of the patient. The video monitor is placed to the left of the patient.
10.2 Recommended Instruments
A 0° endoscope
Two 10-mm trocars
Three 5-mm trocars
A 12-mm trocar with reducer
Three 5-mm fenestrated grasping forceps
Five-millimeter coagulating shears
Three 5-mm straight grasping forceps
A 5- or 10-mm harmonic scalpel
A 10-mm fenestrated forceps
A 10-mm curved dissector
A 5-mm needle holder
One 12-mm linear stapler
One circular stapler
A plastic protective surgical drape with a 7-cm opening
10.3 Total Colectomy with Rectal Resection Is the Addition of a Left Colectomy Followed by a Right Colectomy
Two video monitors on both sides of the patient simplify the subsequent posi- tions of the surgeon, who starts with the left colon resection and ends with the right colon resection.
The specimen is delivered through a right Mac Burney-type incision. The sta- pled ileal J-pouch is created at that time in open surgery. A protective ileostomy can also be done.
10 Laparoscopic Total Colectomy 150
The bowel is placed back in the peritoneal cavity, taking extreme care to avoid rotating the distal mesentery.
The lateral ligaments are controlled using the harmonic scalpel, linear stapling or coagulating systems. Total excision of the mesorectum is performed in case of total coloproctectomy.
The low transection of the rectum is preferably performed using an articulated linear stapler.
In all cases, 1 cm to 5 mm of rectal tissue remains after stapling, allowing circu- lar stapling.
Omentoplasty is always possible by freeing the greater omentum and keeping its left vessels. Omental vessels are controlled by the harmonic scalpel or with clips.
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