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A D V E R T I S E M E N T
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A D V E R T I S E M E N T | |||||
Laparoscopic Soave Images | ||||||
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Description / Link to Frame |
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Pre-op photo, 1-year old patient with Hirschsprung's disease and right lower quadrant colostomy. |
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Pre-op photo with overlaid sketch of colon. |
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Operating room layout. |
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Stoma sewn shut with 3-0 nylon purse string suture. |
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Digital rectal exam. |
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Circumferential prep allows patient to be rotated during procedure. |
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Laparoscopic port placement. |
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Surgeons in position for laparoscopic abdominal portion of procedure. |
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Laparoscopic view from right upper quadrant camera port shows end colostomy and rectal pouch. |
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Laparoscopic view from right upper quadrant camera port shows end colostomy and rectal pouch (labeled). |
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Colostomy dissected free from abdominal wall connections. |
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Colon transected just below stoma using Endo-GIA stapler. |
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Lateral attachments of left colon divided. |
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Colon mobilized sufficiently to reach deep inguinal ring without tension. |
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Rectal pouch mobilized and dissected circumferentially free of pelvic attachments. |
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Silk stay sutures placed at level of dentate line to evert anus. |
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Eversion of dentate line, cross-sectional view. |
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All stay sutures in place. |
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Rectal mucosa is marked with cautery above dentate line. |
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Saline injected submucosally. |
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Mucosa separated from submucosa using cautery. |
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Level of mucosal division, cross-sectional view. |
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Submucosal plane development complete. Mucosa stripped from muscle using fine-needle cautery and cotton-tipped applicators. |
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Eversion of mucosal sleeve, cross-sectional view. |
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Forceps placed down mucosal sleeve to aid dissection. |
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Dissection reaches peritoneal reflection. |
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Eversion of the denuded muscular wall of rectum, cross-sectional view. |
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Muscle edge grasped and opened with cautery. |
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Circumferential division of the rectal wall. |
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Removal of the mucosal sleeve and Hartman's pouch. |
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Colon pulled through opening, cross-sectional view in case without colostomy. |
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Mesentery divided, cross-sectional view in case without colostomy. |
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Remaining muscle sleeve after removal of distal mucosa and proximal colon. |
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Muscle sleeve split posteriorly with cautery. |
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Trochar introduced into abdomen through muscular rectal cuff. |
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Grasper passed. |
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Grasper passed through rectal cannula. |
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Stapled end of colon grasped, laparoscopic view. |
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Colon pulled through muscle sleeve, laparoscopic view. |
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Colon pulled through muscle sleeve, cross-sectional view. |
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Stapled end of colon visible at anal verge. |
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Staple line removed. |
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4-0 Vicryl sutures placed through full thickness of pulled-through colon. |
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Initial sutures placed at 12, 3, 6, and 9 o'clock. |
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After first four sutures placed, quadrants are filled in. |
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Completed neoanus. |
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Abdomen after closure of port sites and removal of stoma. |
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This page was last modified on 3/20/2000. A D V E R T I S E M E N T
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