• Trocar sites are identified, and trocars inserted to gain access to the abdominal cavity. Generally, 3-4 trocars are required. 
  • Initial Access to the abdomen is generally obtained by either:
  • Explore the abdominal cavity and address any adhesions.
  • Mobilize the sigmoid and descending colon, choosing lateral to medial or medial to lateral based on preference.
  • Mobilize the upper rectum in the presacral space and transect the bowel at the junction of the sigmoid colon and upper rectum, using a stapling device, such as ECHELON™ 3000 Stapler. Use a blue or green load based on bowel thickness.
  • Transect the proximal sigmoid colon and remove specimen (wound protector can be used to minimize surgical site infection). 
  • Perform intra-corporeal anastomosis by creating an enterotomy in the sigmoid colon, passing the anvil, and transecting the colon, using a circular stapling device such as ECHELON™ Circular Powered Stapler (Commonly use 29 mm).
  • Alternatively, perform extra-corporeal anastomosis after extracting the specimen, passing the anvil, and transecting the bowel.
  • Conduct a leak test using sigmoidoscopy.
  • Optionally, perform an ICG (indocyanine green) safety test before or after anastomosis to ensure vascularity.
  • Extract the specimen through one of the port sites using Alexis to protect the wound from infection.

Potential complications include but are not limited to:

  • Surgical bleeding
  • Staple line Leak
  • Wound infection
  • Ileus
     

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