Description of Procedure: In the supine position with appropriate monitoring she received general endotracheal anesthesia with IV antibiotic. Foley catheter was placed and she is placed into padded stirrups. Orogastric tube was placed. The abdomen was widely prepped with chlorhexidine and draped. I had irrigated the rectum with Betadine saline. The abdomen is entered through an infraumbilical 7 cm incision with GelPort introduced with a dry laparotomy pad and insufflation. 2 separate 12 mm dissecting ports were placed, on the left about one third from the umbilicus to the ASIS which would be a site for colostomy if required. On the right side, more laterally in the iliac fossa. The abdomen is explored, and I used the Enseal to separate normal attachments of the right uppermost rectum and then to separate with more blunt dissection the filmy adhesions of the anterior mid rectum to the underside of the uterus. I do not fully dissect this area since its distal to the area of interest. I am able to encircled the proposed excision site which is probably the junction of the rectum with sigmoid, and then a blue load laparoscopic stapler was introduced on the right side with transverse amputation, blue load selected because of the colon is thin and not inflamed. Now the corresponding mobilized mesentery is divided on the midline at about the sacral promontory, using the Enseal. We released the descending mesentery over the left sacral brim and now deflate. With open technique, and exposure, the right and left sigmoid mesentery was scored and transilluminated and Enseal used to divide vessels without bleeding. The proximal sigmoid is selected, and a small enterotomy placed. The 31 mm anvil with sharp point is introduced and proximal to this we amputate with a green load stapler, the colon is normally thick here. The specimen is removed and I cut it on the back table showing a 5 cm nonbleeding blanched ulceration which is circumferential. This is submitted in formalin and my gloves were exchanged. Returning to the operative field, the anvil point is brought adjacent to the staple line, the surrounding fat is cleared and the tissues reintroduced and the abdomen reinsufflated.
*
From below I introduced the 31 mm carrier with one hand in the abdomen the ED instrument is gently advanced to the stapled rectum and the stem is introduced. We assure normal orientation of the descending colon and the apparatus is connected and closed under vision, fired using manufacturer’s instruction and retrieved. With the proximal pelvic: Compressed, saline and air are introduced showing appropriate distention and no leak of air or liquid