Colectomy with ileorectostomy, laparoscopic

Due to the obesity and a periumbilical scar, the pneumoperitoneum is established with the Veress needle subcostally on the left. First, in the right mid-abdomen, a channel for a 10 mm trocar is bluntly created with scissors and the trocar is placed. Now, under direct vision, a further 10 mm trocar is introduced at the umbilicus and a 5 mm trocar is inserted into the right lower abdomen. Through the latter, adhesions to the median umbilical ligament are initially released close to the abdominal wall as far as the urinary bladder. Subsequently, a 12 mm trocar can be introduced suprasymphyseally, in the area of the planned Pfannenstiel incision. Two further 5 mm trocars are placed in the left mid- and upper abdomen, the latter making use of the insertion site of the Veress needle.

First, the terminal ileum, the caecum and the ascending colon are mobilised from below and laterally, preserving Gerota's fascia.

Note: During preparation of the right hemicolon, the surgeon and first assistant stand on the patient's left side, facing the monitor on the patient's right side. From the preparation of the left hemicolon (step 7) until the end of the operation, the sides are switched, and a second monitor is set up on the patient's left side for this purpose.

The mobilization of the ascending colon with the mesenteric root up to the duodenum on the Gerota's fascia is completed with free dissection of the duodenum. In this process, the right colonic flexure is dissected from the side and above, transecting adhesions to the gallbladder and a double-barrel formation between the ascending colon and the transverse colon.

Now the gastrocolic ligament is transected while opening the omental bursa. The greater omentum remains in situ and is dissected from the transverse colon from left to right.