Formation of loops in the colon
A. Formation of loops in the colon can cause patient discomfort, difficulty in advancing the scope, and may increase the risk of perforation. B. Here an alpha loop has been formed in the sigmoid colon, facilitating passage into the descending colon. Clock
Intubation by looping
Intubation by looping. A. The sigmoidoscope is advanced to the distal sigmoid. B. Counterclockwise torquing during further advancement loops the proximal sigmoid in front of the distal sigmoid. C. The looped sigmoid flattens the angle at the distal-descen
Trocar site placement colon resections
Trocar site placement for laparoscopic pull-through and other colon resections.
Identification of the left kidney
Identification of the left kidney and gonadal vein after medial mobilization of the colon and spleen.
The colon is retracted toward anterior abdominal
The colon is retracted toward the anterior abdominal wall as the vascular pedicle is divided with the linear cutting stapler.
Retracting the peritoneum laterally
With the patient rotated to the left in steep Trendelenburg position, the surgeon retracts the peritoneum laterally while the assistant retracts the right colon medially.
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.
Mobilization of right colon.
Mobilization of right colon. Two graspers pull the right colon medially as the white line of Toldt is incised.
Endoscopic view of hiatal hernia
The is the forward and reflexed view in a patient with severe GERD demonstrating a hiatal hernia