Preoperative preparation before laparoscopic colectomy includes ensuring that the patient’s medical comorbidities are well controlled and that he or she is an acceptable candidate for surgery. Preoperative teaching of the patient and family should include instructions on the patient’s postoperative responsibilities. These instructions include early eating and ambulation, use of incentive spirometers, and expectations for early discharge. Implementing an enhanced recovery after surgery (ERAS) pathway, which is oftentimes utilized on patients having minimally invasive surgery, reduces hospital length of stay with morbidity and low readmission rates similar to those of patients treated off protocol.

Bowel preparation is a controversial practice for left colectomy. Multiple prospective randomized studies have been performed examining the outcome of elective colonic resections with and without bowel preparation. Reports have shown no difference in complication rates, including anastomotic
leaks, whereas others have demonstrated a higher rate of wound infections in the patients who have received a bowel preparation. Reduced surgical site infections occur in patients who received mechanical and oral antibiotic bowel preparation. Intraoperative colonoscopy for localization of polyps or tumors during the surgery will require mechanical bowel preparation. It is the practice of the authors to prepare the patients with a mechanical and oral antibiotic bowel preparation for all colorectal resections. If no mechanical oral preparation is used for a laparoscopic left colectomy, the patient should perform two disposable phosphate enemas before entering the operating room to allow unimpeded transanal passage of a circular stapler.

Final preoperative preparation includes instillation of intravenous antibiotics, application of a warming preoperative warming blanket, administration of subcutaneous heparin, and application of sequential compression stockings. Placement of an epidural catheter is advocated by some surgeons for postoperative pain management to limit postoperative narcotic intake and to enhance recovery; however, for laparoscopic resections, placement of a transversus abdominal plane (TAP) block is preferred by the authors. Adequate intravenous access is obtained before positioning the patient in the operating room because both arms will be tucked at the patient’s side during the operation. A foam matt, or non-slip pad, is placed between the bed and the patient and after tucking both arms and placing the patient in the modified lithotomy position (or splitting the legs on a split table), the patient is secured to the table. These steps are necessary to prevent the patient from moving during the operation, because often steep Trendelenburg with the patient’s left side elevated are required to keep the small intestine out of the operative field.

When approaching a laparoscopic colectomy, standardizing the surgical technique helps facilitate the operation, allowing it to be performed in a quick and efficient manner. This method will decrease surgeon frustration and operative time. Each step must have specific targets and those targets should be reached in a timely manner. If the surgeon is not meeting those goals and the operation is failing to progress, early conversion is advocated and may reduce the risk of intraoperative complications. Just as standardization facilitates performing the procedure, instituting standardized preoperative and postoperative care pathways have shown to be safe and cost-effective, reducing patient length of stay and decreasing costs and complications.