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Laparoscopic resection of the colon is most commonly indicated for benign colon conditions such as chronic diverticulitis and large polyps that are not amendable to removal during colonoscopy. The laparoscopic approach is being used with increasing frequency for carcinoma. In general this approach is not recommended in patients with emergency conditions such as obstruction, perforation, or massive bleeding.
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For patients having surgery for polyps and occult neoplasms, it is essential to have the lesion tattooed during colonoscopy or localized by a preoperative barium enema. Identification of the tumor during laparoscopy is usually difficult. The use of intraoperative colonoscopy is difficult during laparoscopic procedures; hence, accurate preoperative localization is necessary. The patient should receive a standard mechanical bowel preparation, and prophylactic antibiotics are administered within one hour of the incision and are to be discontinued within 24 hours of surgery. Subcutaneous heparin is administered and sequential compression devices are placed for prevention of venous thromboembolism.
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General anesthesia is required. An orogastric or nasogastric tube is inserted.
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The patient is positioned in the modified lithotomy position with the legs supported on stirrups. Padding is used to protect all pressure points. The left arm is tucked. The patient should be secured to the operating table with tape, as repositioning of the table may be needed to enhance exposure during the operation. The operating room setup is shown in Figure 1A. The surgeon and camera operator stand to the patient's left. The assistant stands between the patient's legs. Two video monitors are used as shown.
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The skin is prepared in the routine manner and a sterile plastic drape applied.
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Access to the peritoneal cavity is achieved by an open or Hasson technique. An infraumbilical incision is made and a 10- to 12-mm Hasson port inserted. The abdomen is insufflated to 15 mm Hg. A 30-degree-angled scope is employed. After the Hasson port is inserted, there are three commonly used port placements (Figure 1B). The first configuration is shown in Figure 1B has a 10-12 mm trocar to the left of the midline in the left lower quadrant with ...