The anvil is attached to the circular stapler (which has been passed transanally); the stapler will be closed and fired in the usual fashion.
A. The anvil of the circular stapler is inserted in the proximal end of the bowel (which has been drawn out of the abdomen through an enlarged trocar site). B. The pursestring suture is tied. The bowel is then returned to the abdomen.
The endoscopic linear stapler is used to divide the bowel at the distal resection margin.
Mobilization of the sigmoid colon to expose the left ureter as it crosses the pelvic brim. The iliac vessels are seen to the left of the ureter.
Placement of 10- to 12-mm trocars for laparoscopic assisted left colon resection. Two optional trocar sites (right upper quadrant and left lower quadrant) are occasionally helpful: , typical trocars; ¥, optional trocars.