V4 Total laparoscopic restorative proctocolectomy for ulcerative colitis

Abstract

Introduction: Laparoscopic ileal pouch‐anal anastomosis (IPAA) has been shown to be a safe and feasible technique for patients with ulcerative colitis refractory to medical management and familial polyposis. We aim to demonstrate our technique of total laparoscopic proctocolectomy with intracorporeal pouch‐anal anastomosis with specific reference to intaroperative tricks of the trade.Patient and Methods: The patient is a 16‐year‐old male with ulcerative colitis. The video demonstrates a total laparoscopic proctocolectomy and formation of a (J) ileal pouch anal anastomosis. A standard colonic mobilisation of the colon was performed with the use of the Goldfinger retractor to aid vessel division and the use of the harmonic scalpel for mesenteric division apart from the transverse mesocolon where the ligasure was employed. The right colon was only mobilised after complete mesenteric division of the left & transverse colon to prevent looping. The rectum, once mobilised to the pelvic floor, was divided in the AP direction with the endoGIA. Techniques to prevent twisting of the pouch and inadvertent twisting of the proximal small bowel are demonstrated. The video also highlights the importance of positioning the patient and use of 0 and 30 degree scopes. A technique to tackle a defect in the anal stump is also described.Conclusion: The technique of laparoscopic IPAA adheres to the principles of open pouch surgery but we await the development of more suitable laparoscopic staplers to aid the clinician in division of the anorectal junction.