Laparoscopic Low Anterior Resection with Diverting Loop Ileostomy for Rectal Cancer with Conversion to Open Approach

1. Introduction

2. Access and Placement of Ports

3. Colon Mobilization

1. Free and Elevate Omentum
2. Pull Transverse Colon Down and Enter Lesser Sac
3. Descending Colon and Splenic Flexion Mobilization
4. Clip and Divide Left Colic Artery
5. Finish Proximal Mobilization
6. Sigmoid Colon and Rectum Mobilization
7. Isolation and Division of IMA Pedicle
8. Continue Distal Mobilization

4. Conversion to Open Approach

5. Proximal Bowel Division

1. Marginal Artery Division

6. Extension of Incision

7. Total Mesorectal Excision

1. Check Tumor Location with Colonoscope

8. Division of Rectum

9. Distal Side-to-End Anastomosis with EEA Stapler

10. Test Anastomosis

11. Closure

1. Prepare Loop Ileostomy Exit Site
2. Close Abdomen
3. Staple Port Incisions
4. Inject Local Anesthetic
5. Staple Midline Laparotomy Incision
6. Mature Loop Ileostomy

12. Post-op Remarks