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I42 .

Surgicol Procedures lncluding Minimol Access Procedures

Gostroiniebtinqt Surgery

o l{$

Resection oflhe Rectum. The surgery is initially identical to low anterior resection except that the distal dis-

Laparoscopically'Assisted Abdominal Perineal

lnstruments

in situ

section is performed as low as feasible; the specimen is left as the proximal end is transsected. The proximal segment is then brought out as an end colostomy at a previously selected stoma site in the left lower'quadrant.

Major procedures tray (open) Iong instruments tray Gastrointestinal procedures tray
_Laparoscope

Verres needle

with camera and cord, endoscopic

Preporotion of the Potient

For right hemicolectomy the patient is in -Iithotomy with tfie left side up And the table in Trendelenburg' For left hemicolectomy the patient is supine with the left side up and the table in Trendelenburg. With laparoscopic low anterior resection, the patient is in modified lithotomy with the table in Trendelenburg. Tf,e patient is supine for the Hartmann's procedure' To rev6rse the Hartmann's procedure (closure of colostoiny), the,patient is placed in lithotomy using Allen-

Endoscopic blunt tip trocar Endoscopic 10 to 11 mm or 10 to 12 mm sharp trocar (4) Endoscopic Babcock clamps, 10 mm (2) Endoscopic curved scissors, b mm Endoscopic right-angle dissector, 10 mm Tlndoscopic Kelly clamp, 10 mm Endoscopic multiple clip applier Endoscopic right angle and hook suction-electrosurgi-

cal dissectors

Endoscopic hook scissors Endoscopic extrudable fan retractor Endoseopic grasping clamps (2)

Endoscopic dissecting clamp3 (2)

t tyod-lavies stirrups. Insert a Foley catheter' Apply


eleitrosurgical pad.
Skin Preporotion

Snioscopic probe with suctiori, irrigation Endoscopic ligate and divide staplei t-doscopic linear cutter (intracorporeal) Fndoscopic linear cutter (extracorporeal) Endoscopic intraluminal end-to-end stapler
En"

from nipples to upper thighs and down to.the table at

For the'right and left hemicolectomy and Hartmann's p"o."-drr"", begin at the umbilicus extending

ioscopic modified anvil grasper


doscopic needle driver

the sides. For the low anterior resection, begin at the umbilicus extending from nipples to the pubic symphysis, and down to the table at the sides. Follow this with a vaginal preparation.(women) and include the genitalia. bl"uttiu each inner thigh. Prepare the perIneutn and anus'last, discarding'each sponge after wiping the anus.

pplies
Radding foam for pressure points $andbag under sacrum (only for Abdominal perineal)

Droping

For right and lefthemicolectomy and Hartmann's For low anterior resection. Drape sheet under buttocks, and a special laparoscopy sheet with attached
leggings.

hdoscopic specimen retrieval bag

reduction agent catheter astric tube (e.g., No. 16) Xlades (2) No. 10, (1) No.'15, (1) No.

fuction tubing frdoscopic suture

loops

11

prd;idures.

Folded towels and a laparoscopy:sheet'

heumatic antiemboletic stockings


tubing
I pressure device

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