OPERATION: Laparoscopic High Anterior Resection
ANAESTHETIC: General anaesthesia
WHO Checklist. VTE prophylaxis. IV antibiotics. Urinary catheter. Lloyd-Davis position.
FINDINGS: [Tumour in distal sigmoid or upper rectum. Tattoo visible. No visible metastatic disease].
PROCEDURE:
10mm supraumbilical port via modified open Hasson technique.
x2 5mm and x1 10mm ports under direct vision.
Sigmoid colon adhesions taken down.
Medial to lateral mobilisation. Left ureter identified and protected.
IMA pedicle dissected and taken with Hem-o-lok clips.
Lateral to medial mobilisation. Splenic flexure taken down.
TME plane entered to mobilise upper rectum. Pelvic nerves protected.
Mesorectum divided. Rectum divided with EndoGIA60.
Midline utility incision. Alexis wound protector.
Pursestring applicator used to secure colonic anvil.
Stapled end-to-end colorectal anastomosis with powered CDH29.
Orientation checked. Negative air leak test. Haemostasis achieved.
CLOSURE:
J-0 PDS to 10mm port sites.
Rectus sheath closed with 1 PDS. 3-0 Monocryl to skin.
20ml levobupivacaine to wounds.
POST-OPERATIVE INSTRUCTIONS:
VTE prophylaxis. Analgesia. Mobilise. Chest physiotherapy.