Laparoscopic Sigmoidectomy for Diverticulitis

Introduction Structure and handling of the Operation Primer I Preparations for the operation Instruments Emptying the bladder Positioning of the patient Shaving Neutral electrode Setting the equipment Skin disinfection Sterile draping Positioning of the operating team II Creating the pneumoperitoneum – placing the optical trocar a) Hasson Method (open technique) b) Trocar with obtical obturator c) Veress needle (closed technique) III Placing the working trocars Placing the working trocars IV Nodal points 1. Exploring the abdominal cavity 2. Identifying the anatomical landmarks 3. Mobilizing the left lateral colon 4. Mobilizing the splenic flexure 5. Dissecting the sigmoid mesentery 6. Dissecting the upper mesorectum 7. Dividing the upper rectum 8. Extracting the sigmoid 9. Dividing the proximal colon and preparing the anastomosis extraabdominally 10. Preparing the anastomosis intraabdominally 11. Anastomosing the colon 12. Verifying the anastomosis 13. Finishing the operation V Management of difficult situations, complications and mistakes 1. Adhesions 2. Blood vessel injuries a) Diffuse bleeding / bleeding from minor vessels b) Bleeding from major vessels 3. Organ injuries a) Greater omentum b) Bowel c) Spleen d) Stomach e) Liver 4. Preperitoneal air emphysema a) Veress needle b) Trocar 5. Losing a swab in the abdominal cavity 6. Adhesion of the sigmoid to the abdominal wall 7. Injury of the left ureter 8. Injury of iliac vessel 9. Difficulties when clipping a) Incorrectly positioned clips b) Unsafelypositioned clips c) Lost and slipped clips 10. Positive anastomotic leak test 11. Rotation ot the left colon VI Anatomical variations Sigmoid position variations Appendix Sample operation note Bibliography Liste of key words