COLORECTAL   > Laparoscopic Total Proctocolectomy with IPAA
Patient and Port position : Patient placed in modified Lloyd Davies position.

Pneumoperitoneum created by veress needle through 10 mm Supraumbilical skin incision which was later on is converted into 10mm camera port.  12mm port at RIF, 5mm ports at epigastric region, right lumbar, 10mm ports at LIF and supraumbilical area are made.

STEPS:
Initial step is to visualize all quadrants of peritoneal cavity, liver surfaces, and pelvis for metastasis, lymphadenopathy and ascites.

IMV and IMA dissected, clipped at their origins and divided. Ileocolic, right colic and middle colic vessels dissected, clipped at their origin and divided.  Right and left ureter identified and course traced.  Rectum dissected circumferentially in anatomical planes upto pelvic floor. Rectum divided by endo GIA stapler (green) at the level of anorectal junction. Lesser sac opened.  Splenic and hepatic flexure dissected.  Distal ileum mobilized. Right and left white line of Toldt’s dissected. Lateral attachment of colon, divided, lesser sac opened. Splenic and hepatic flexure mobilized. 5cm pfannenstiel incision given and specimen taken out. Specimen separated after dividing ileum at IC junction. 15cm length ileal pouch created by stapler. Anvil fixed to the tip of pouch and replaced to peritoneal cavity. No29 CDH stapler passed through anus and ileal pouch anal anastomosis (IPAA) done. Loop ileostomy created at right iliac fossa 30cm proximal to IPAA.