Abdominal phase

A standard three port laparoscopic set-up (10 mm port and two 5 mm) was generally employed. A 30° camera was introduced through the 10 mm subumbilical port that had been placed by means of a Hassan technique. The other two 5 mm ports were inserted in the right iliac fossa at the level of the anterior superior iliac spine and in the right lumbar region at the level of the umbilicus. In patients with previous total colectomy, the trans-peritoneal approach was limited to any necessary adhesiolysis and securing mobilisation of the small bowel out of pelvic cavity in addition to identification of the rectal stump and dissection of the cephalad one-third of the rectum (to the level of the seminal vesicles or recto-vaginal plane as applicable anteriorly). In two cases with prior total colectomy, end ileostomy and parastomal hernia, the laparoscopic component was performed instead via a single port placed at the site of their mobilised end ileostomy. For those undergoing abdominoperineal resection for cancer, the left colon was mobilised via a medial to lateral approach with high ligation of the inferior mesenteric artery. The left ureter was always identified and protected.