Laparoscopic Sigmoidectomy for Cancer

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 lymph nodes and the sigmoid mesentery.- 6. Dividing the inferior mesenteric vessels.- 7. Dissecting the upper mesorectum.- 8. Dividing the upper rectum.- 9. Extracting the sigmoid .- 10. Dividing the proximal colon and preparing the anastomosis extraabdominally.- 11. Preparing the anastomosis intraabdominally.- 12. Anastomosing the colon.- 13. Verifying the anastomosis.- 14. 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 and pancreas.- 4. Preperitoneal air emphysema - a) Veress needle, b) Trocar.- 5. Losing a swab in the abdominal cavity.- 6. Difficulties when identifying the inferior mesenteric artery.- 7. Adhesion of the sigmoid to the abdominal wall.- 8. Injury of the left sympathic trunk.- 9. Injury of the left ureter.- 10. Injury of the iliac vessels.- 11. Difficulties when clipping.- a) Incorrectly positioned clips, b)Unsafely positioned clips, c) Lost and slipped clips.- 12. Positive anastomotic leak test.- 13. Rotation of the left colon.- 14. Spastic colon.- 15. Spread of tumour cells.- VI Anatomical variations.-Vascular variations.- Sigmoid position variations.- Appendix.- Sample operation note.- Bibliography.- List of key words.