Colorectal

Segmental Colectomy (Laparoscopic)

OPERATION: Laparoscopic-Assisted Segmental Colectomy — [Left Hemicolectomy / Sigmoid Resection / Right Ileocolic Resection]
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: IV antibiotics at induction
POSITION: Supine. Urinary catheter. VTE prophylaxis applied. [Left / right] side of table down for colonic mobilisation.

INDICATION:
[Colonic carcinoma / diverticular disease / Crohn's disease / volvulus]. Preoperative colonoscopy [with tattoo marking]. CT staging [findings]. [Neoadjuvant treatment if applicable].

PROCEDURE:
WHO Checklist performed. Abdomen prepared and draped.

PORT PLACEMENT:
10/12 mm camera port placed via open Hasson technique at the supraumbilical / infraumbilical site — planned extraction incision. 30° laparoscope. Pneumoperitoneum to 15 mmHg. Two further working ports placed lateral to the rectus muscle on the [right / left] side as appropriate for the planned resection. [Additional trocar placed in the opposite upper quadrant if splenic / hepatic flexure mobilisation required]. Abdomen and liver inspected for metastatic disease.

MOBILISATION:
Table in steep Trendelenburg with [right / left] side down. Small bowel swept from operative field.

FOR LEFT HEMICOLECTOMY / SIGMOID RESECTION:
Sigmoid / left colon grasped and retracted medially. White line of Toldt incised with energy device from sigmoid to splenic flexure. Dissection medialised to expose Gerota's fascia, left ureter [identified and protected at the pelvic brim throughout], and sacral promontory. Table to reverse Trendelenburg for splenic flexure. Greater omentum lifted cephalad; gastrocolic omentum divided to level of middle colic artery. Transverse colon and splenic flexure dissected from the retroperitoneum.

Intracorporeal vessel ligation: Left colon retracted anterolaterally. [Inferior mesenteric artery / superior rectal and left colic arteries] isolated by scoring mesentery, creating windows on each side, and divided with energy device / vascular stapler / clips after confirming left ureter is clear. Inferior mesenteric vein similarly divided. Smaller sigmoid mesenteric vessels controlled individually. Distal resection margin exposed circumferentially on the colonic / rectal wall. Bowel divided with 60 mm linear cutting stapler.

FOR RIGHT ILEOCOLIC RESECTION:
Cecum retracted superomedially. White line of Toldt incised from cecum superiorly to hepatic flexure. Ureter, Gerota's fascia, and duodenum identified and protected. Gastrocolic ligament divided toward the hepatic flexure. Hepatocolic ligament divided. Ileocolic artery isolated by elevation of the mesentery creating mesenteric windows on each side and divided with energy device / vascular stapler / clips [high ligation for malignancy]. Terminal ileum divided with laparoscopic stapler.

SPECIMEN EXTRACTION AND ANASTOMOSIS:
Specimen positioned for extraction. Pneumoperitoneum released. Wound protector applied to the camera port site — extended to 2–4 cm vertically. Bowel delivered extracorporeally.

LEFT / SIGMOID: Proximal colon divided extracorporeally. Purse-string suture placed. Circular stapler anvil inserted in proximal bowel and secured. Bowel returned to abdomen. Pneumoperitoneum re-established. Circular EEA stapler introduced transanally and connected to anvil. Anastomosis fired — both donuts intact. Anastomosis tested laparoscopically.

RIGHT: Side-to-side functional end-to-end ileocolic anastomosis performed extracorporeally with GIA stapler. Common enterotomy closed with TA stapler. Anastomosis returned to abdomen.

Extraction wound closed. Pneumoperitoneum re-established. Abdomen inspected — anastomosis patent, no bleeding. Haemostasis confirmed. All ports removed under direct vision. Port fascia closed. Skin subcuticular suture.

FINDINGS:
[Tumour / diverticular disease / segment involved]. [Tattoo confirmed in specimen for malignancy]. Left ureter / duodenum protected. [Resection margins adequate macroscopically]. No visible peritoneal or liver metastases.

SPECIMEN: [Colonic segment] to histopathology [orientated if malignancy].
EBL: [Volume] ml. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Enhanced recovery protocol. Oral fluids when tolerating. VTE prophylaxis continued. Outpatient review with histology.