Laparoscopic anterior resection

ANATOMY
Can to down to approx 8cm
Nerves
Ureters

PROCEDURE
RIF 10mm port
RUQ 5mm
2 more 5mm ?where on left side
Lithotomy position with legs low so instruments don’t clash
3 x lap DeBakeys
Harmonic scalpel (use diathermy/scissors of not available)
Always mobilise to splenic flexure, including
dissecting the greater omentum off the colon.
The line of dissection is always more on the colon side than you think! (the registrars mistake: this is where you will get bleeding and hit the ureter)
On table colonoscopy to confirm site of lesion
Make window in mesocolon after identifying ureter and gonadals
35mm endostaple IMA and IMV (may have to do separately in cancer operation.)
Care with nerves esp in male (these will be behind rectum)
May have to staple vessels lateral to rectum down low.
35mm endostaple with a few reloads to transect rectum
LIF appendicectomy incision with wound protector to mobilise colon and tie on anvill
Make sure you clear all fat from colon over staple line.
Purse string PDS continuous then second inner ring.
Maxon to 10mm RIF port.