Operation Primer 2: Laparoscopic Sigmoidectomy for Diverticulitis

About this book

• Details the latest surgical procedures
• Provides excellent photographic guidance
• Offers step-by-step guidance

The Operation Primer "Laparoscopic Sigmoidectomy for Diverticulitis" gives a detailed overview of the patients’ preparation, surgical key steps, and pitfalls of laparoscopic sigmoidectomy for diverticulitis. The major goal was to provide a comprehensive surgical guide book for laparoscopic colorectal surgeons helping to avoid those pitfalls leading to complications.

Written for:

• Surgeons

Keywords:

• Laparoscopy
• Surgery

CONTENTS

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 optical 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 fl exure
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 extra-abdominally
10. Preparing the anastomosis intra-abdominally
11. Anastomosing the colon
12. Verifying the anastomosis
13. Finishing the operation

V Management of diffi cult 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
f ) Pancreas
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 the iliac vessels
9. Diffi culties when clipping
a) Incorrectly positioned clips
b) Unsafely positioned clips
c) Lost and slipped clips
10. Positive anastomotic leak test
11. Rotation of the left colon

VI Anatomical variations
Sigmoid position variations

Appendix
Sample operation note
Bibliography
List of key words