The patient is placed supine on the operating table on a bean bag. After induction of general anesthesia and insertion of an orogastric tube and a Foley catheter, the patient’s legs are placed in yellow fin stirrups. The arms are tucked at the patient’s side and the bean bag is aspirated. The abdomen is prepared with antiseptic solution and draped routinely (Chapter 2).

The primary monitor is placed on the right side of the patient at the level of the hip. The operating nurse’s instrument table is placed between the patient’s legs. There should be sufficient space to allow the operator to move from either side of the patient to between the patient’s legs if necessary. For an ileostomy, the primary operating surgeon stands on the left side of the patient with the assistant standing on the patient’s right, and moving to the left side, caudad to the surgeon once ports have been inserted. For a colostomy, the primary operating surgeon stands at the right side of the patient with the assistant standing on the patient’s left, and moving to the right side, caudad to the surgeon once ports have been inserted. A 0-degree camera lens is used.

This is performed using a modified Hasson approach (Chapter 3). A vertical 1-cm subumbilical incision is made. This is deepened down to the linea alba, which is then grasped on each side of the midline using Kocher clamps. A scalpel (no. 15 blade) is used to open the fascia between the Kocher clamps and Kelly forceps are used to open the peritoneum bluntly. It is important to keep this opening small (<1 cm) to minimize air leaks. Having confirmed entry into the peritoneal cavity, a purse string of 0 polyglycolic acid is sutured around the subumbilical fascial defect (umbilical port site) and a Rommel tourniquet is applied. A 10-mm reusable port is inserted through this port site allowing the abdomen to be insufflated with CO₂ to a pressure of 12 mmHg.