How are endostapling, specimen exteriorization, and construction of anastomosis performed during laparoscopic left hemicolectomy?

Updated: Apr 13, 2020
  • Author: David B Stewart, Sr, MD, FACS, FASCRS; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Application of an endostapler to the proximal and distal resection margins, followed by specimen exteriorization and creation of an anastomosis, is self-explanatory (see the videos below).

Laparoscopic left colectomy. Transection of descending colon with endostapler.
Laparoscopic left colectomy. Endostapler transection of rectum.

Every effort should be made to transect as much mesentery as possible toward the bowel wall before stapler application in an effort to prevent bleeding after stapling. The endostaplers must be placed straight across the bowel, not at an angle; angled placement creates zones of ischemia, as well as a higher risk of inadequate margins of resection for cancers. If postcolectomy bleeding occurs, it may be treatable by means of endoscopy. [25]

A study assessing the effect of the site used for speciment extraction on the incidence of wound infection after laparoscopic colon resection found that infection rates were higher when midline or Pfannenstiel incisions were used for specimen extraction and lower when right-lower-quadrant or left-lower-quadrant incisions were used. [26]


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