Dr Pradeep Jain is currently appointed the Chief of Department GI, GI
Onco, Bariatric & MinimalAccessSurgery, at Action Cancer Hospital
& Sri Balaji Action Medical Institute .
Patient and Port position: Patient placed in modified Lloyd Davies position.
Pneumoperitoneum
created by veress needle through 10 mm Supraumbilical skin incision
which is later on converted into 10mm camera port. 10mm RIF port, 5mm
right and left lumbar ports, 12mm supraumbilical ports made.
STEPS: Initial
step is to visualize all quadrants of peritoneal cavity, liver
surfaces, pelvis for metastasis, lymphadenopathy and ascites.
The
left side of the patient is raised up to allow the small bowel to fall
out of the pelvis. The apex of sigmoid is held up and to left. The
sacral promontory is identified and the peritoneum over is incised on
the medial aspect of the mesosigmoid. A window is made in the mesocolon
over the IMA. IMA & IMV dissected, ligated and divided at just
distal to their origin the left ureter and gonadal vessels are
identified and carefully preserved during this part of dissection.
Descending colon mobilized from medial to lateral. The descending colon,
splenic flexure and the distal transverse colon are completely
mobilized at the end of this phase. This helps to obtain adequate length
of proximal colonic segment for tension free anastomosis. Rectum
dissected from surrounding structures in anatomical planes upto pelvic
floor. Course of ureter traced. Rectal division done by Endo GIA
staplers (green) just above ano rectal junction. Rectal mass along with
left colon delivered outside through 5cm transverse suprapubic
laparotomy. Specimen removed by dividing left colon. Anvil attached to
distal end of left colon and returned into peritoneal cavity. No. 29 CDH
stapler passed per anus and stapled anastomosis done. Loop ileostomy
created 20cm proximal to IC junction at RIF.
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