Fig. 14.1
Total colon specimen extraction through the umbilical port
- 12.
Intracorporeal anastomosis (steep Trendelenburg)
Return the colon to the abdomen, replacing the port, and re-insufflating the abdomen. Assure the orientation of the colon is not twisted by following the cut edge of the mesentery back to the retroperitoneum. Once the orientation is checked, ensure the resected limb with the anvil falls into the pelvis without tension, ensuring adequacy of reach is then determined by placing the colon into the pelvis. Under laparoscopic guidance, insert the size 29 circular stapler transanally into the rectum and carefully advance it up to the apex of the rectal stump. Open the spike on the stapler, aiming for the spike to protrude through just posterior the staple line. Avoid going directly through the staple line, as this can cause the staple line to unzip. Guide the anvil onto the spike, confirming a proper join. The stapler is closed and fired. The anastomosis is tested by grasping and occluding the colon around the level of the sacral promontory and filling the pelvis with irrigating fluid. The rectum is distended with air under water, using a proctoscope or bulb syringe to assess for bubbling. The stapler “donuts” are then examined for completeness.