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Laparoscopic Sigmoid Colectomy by Nezar Jrebi, MD and Jay Redan, MD
Authored by
Nezar Jrebi, MD and Jay Redan, MD
Authored by
Nezar Jrebi, MD and Jay Redan, MD
Laparoscopic Sigmoid Colectomy by Nezar Jrebi, MD and Jay Redan, MD
Operative Steps
Operative Steps
- 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:
- Veress needle technique.
- Direct trocar view technique.
- 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.
- Isolate and transect the inferior mesenteric artery using the ECHELON™ 3000 Stapler or ENSEAL™ X1 Curved Jaw Tissue Sealer.
- 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.
- Mobilize the descending colon and splenic flexure, taking down the white line of Toldt with the ENSEAL™ X1 Curved Jaw Tissue Sealer.
- 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.
- Remove fluid from wound and close the fascia using synthetic absorbable suture, such as PDS™ Plus Antibacterial suture.
- Subcuticular layer and skin are closed using synthetic absorbable monofilament, such as Monocryl™ Plus Antibacterial suture, and a topical skin adhesive such as DERMABOND PRINEO™ Skin Closure System or any appropriate dressing.
Potential complications include but are not limited to:
- Surgical bleeding
- Staple line Leak
- Wound infection
- Ileus