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Open Soave Images

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Pre-op positioning.
VID 103, frame 1

hirP4053

 

Foley catheter inserted.
VID 103, frame 2

hirP4054

 

Pre-op positioning with colon overlaid.
VID 103, frame 3

hirG4055

 

Incision markings.
VID 103, frame 3

hirG4056

 

Transition zone between aganglionic and normal colon.
VID 103, frame 4

hirG4057

 

Stoma for "leveling colostomy".
VID 103, frame 5

hirP4058

 

View after leveling colostomy, with colon overlaid.
VID 103, frame 5

hirG4059

 

Stoma sewn shut prior to stage two of soave procedure.
VID 103, frame 6

hirP4060

 

Incision markings for stage two of soave procedure.
VID 103, frame 7

hirP4061

 

Stoma dissected free of abdominal wall, and two limbs stapled separately.
VID 103, frame 8

hirP4062

 

Stoma section removed and tested for ganglion cells.
VID 103, frame 9

hirG4063

 

Ascending colon mobilized, and checked to see if it reaches pelvis.
VID 103, frame 10

hirG4064

 

Ascending colon mobilized, and checked to see if it reaches pelvis (labeled).
VID 103, frame 10

hirL4064

 

Bulldog clamp placed on artery.
VID 103, frame 11

hirP4066

 

Bulldog clamp used to test colon viability if artery removed.
VID 103, frame 12

hirG4065

 

Artery removed to mobilize ganglionated segment of colon.
VID 103, frame 12

hirG4067

 

Ganglionated colon mobilized.
VID 103, frame 12

hirG4068

 

Once mobilized, ganglionated colon reaches pelvis.
VID 103, frame 13

hirP4069

 

View into pelvis with ganglionated colon under tension.
VID 103, frame 14

hirP4070

 

Long segment of agangiolic colon after its mesentery is divided.
VID 103, frame 15

hirP4071

 

Epinephrine injected into bowel wall to lift mucosa.
VID 103, frame 16

hirP4072

 

Colon prior to injection.
VID 103, frame 16

hirG4073

 

Injection of epinephrine.
VID 103, frame 16

hirG4075

 

Incision made in bowel wall with #15 blade.
VID 103, frame 17

hirP4076

 

Start of incision.
VID 103, frame 18

hirG4080

 

Mucosa dissected free and intact from bowel wall (1).
VID 103, frame 18

hirG4083

 

Mucosa dissected free and intact from bowel wall (2).
VID 103, frame 18

hirG4085

 

Mucosal tube defined.
VID 103, frame 19

hirG4086

 

Stay sutures placed in muscular sleeve to aid dissection.
VID 103, frame 20

hirG4087

 

Muscular cuff split posteriorly to aid dissection.
VID 103, frame 21

hirG4088

 

Mucosal tube descending into muscular sleeve.
VID 103, frame 22

hirP4089

 

Clamp passed into anus to check progress of dissection.
VID 103, frame 23

hirP4090

 

Mucosal sleeve.
VID 103, frame 24

hirG4091

 

Mucosal sleeve grasped and everted out anus (1).
VID 103, frame 24

hirG4092

 

Mucosal sleeve grasped and everted out anus (2).
VID 103, frame 24

hirG4093

 

Mucosal sleeve grasped and everted out anus (3).
VID 103, frame 24

hirG4094

 

Everted mucosa shows completed dissection.
VID 103, frame 25

hirP4095

 

Position of patient when working from below.
VID 103, frame 26

hirP4096

 

Silk stay sutures placed to evert anus.
VID 103, frame 27

hirP4097

 

Mucosal sleeve prior to incision.
VID 103, frame 28

hirG4098

 

Mucosal sleeve opened for half its circumference.
VID 103, frame 29

hirG4099

 

Mucosal sleeve opened for half its circumference (photo inset).
VID 103, frame 29

hirG4100

 

Clamp passed through opened muscular sleeve to grasp colon.
VID 103, frame 30

hirG4101

 

Colon pulled down and through anus.
VID 103, frame 30

hirG4102

 

Staple line removed from ganglionated colon.
VID 103, frame 31

hirG4103

 

Ganglionated colon sutured to anus.
VID 103, frame 31

hirG4104

 

Mucosal sleeve left in place posteriorly for orientation in placing sutures evenly. Sleeve is removed prior to placement of final sutures.
VID 103, frame 32

hirP4105

 

This page was last modified on 7/15/1999.
 

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