Port Positioning and Surgical Field Setup

Ports are positioned as shown in Fig. 7 for laparoscopic resections and in Figs. 8 and 9 for robotic resections. The umbilical camera port is created with an open technique and the remaining trocars are positioned under vision after pneumoperitoneum has been created. For laparoscopy, 10-mm ports are used for the camera, the right hypochondrium and

Fig. 10a, b. Tr, Treitz; IMV, inferior mesenteric vein; IMA, inferior mesenteric artery. The IMV is identified at the ligament of Treitz; the peritoneum is opened underneath the vein

Fig. 11. The mesentery of the left colon is lifted from the fascia of Gerota underneath the inferior mesenteric vein the left flank; a 12-mm port is created in the right iliac fossa to allow for the use of the endo-GIA. Robotic ports are 8 mm and the camera port is 12 mm. The robot is first positioned on a level with the left flank, using the trocars in the right iliac fossa and right hypochondrium, and dissection of the left colon is performed. For dissection of the lower rectum, the position of the robot must be changed to left thigh level and works through the 2 ports in the iliac fossae. If a Miles procedure is adopted, the trocar in the left iliac fossa is used for the colostomy. The patient lies in a Trendelemburg position, rotated to the right. The small bowel is pulled out of the pelvis and positioned in the right hypochondrium to expose the ligament of Treitz, with the origin of the IMV.

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