Image Category: Fundamentals: Segmental Colectomies, Anterior

Attaching the anvil to the circular stapler

The anvil is attached to the circular stapler (which has been passed transanally); the stapler will be closed and fired in the usual fashion.

The anvil of the circular stapler

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

The endoscopic linear stapler is used to divide the bowel at the distal resection margin.

Mobilization of the sigmoid colon

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.

Trocar Placement

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.

anastomos is performed in an extracorporeal manner

Terminal ileum, cecum, ascending and proximal transverse colon eviscerated through the small midline incision. Resection and anastomosis will be performed in an extracorporeal manner. The anastomosis is then returned to the abdominal cavity.

Intracorporeal division of mesenteric pedicle

Intracorporeal division of mesenteric pedicle is an alternative to totally extracorporeal resection.

Mobilization of right colon.

Mobilization of right colon. Two graspers pull the right colon medially as the white line of Toldt is incised.

Trocar Placement

Positions of the 10- to 12-mm trocars for ileocolic resection and right hemicolectomy. The small midline incision is made as an extension of a trocar site and is used for exteriorization of the specimen and extracorporeal resection and anastomosis: , typ

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