The administration of antibiotic was protracted if the patient's postoperative condition required it. OPERATIVE TECHNIQUE It is important to highlight some of the drawbacks associ- ated with a laparoscopic approach in performing rigorous surgical technique. Besides the difficulties inherent in exe- cution of a complex operation, the main problem of laparo- scopic vision is a reduced field of view which can mislead the surgeon in identification of pedicles and structures. It is important, therefore, to identify particular reference points that guide the surgeon in performing the different operations. Experience has taught that for the right colon these reference points are the superior mesenteric pedicle, the middle colic artery and the right genito-ureteral pedicle. For the left colon they are the right iliac artery, the anterior aortic plane, and the duodenum-jejunal angle, whereas for the rectum they are the vesicolodeferential complex in the male, the vaginal peritoneal reflection in the female, and the floor of the pelvis. RIGHT COLECTOMY In video-laparoscopic right hemicolectomy the specimen must be removed through a minilaparotomy incision. For this reason, although it is possible to construct the ileocol- ic anastomosis laparoscopically, it is advisable to perform the anastomosis extracorporeally, using the minilaparotomy site for extraction of the specimen and segments that have to be anastomosed. This makes the procedure easier and can reduce operative time. If one performs the anastomo- sis extracorporeally, the localization of its site must take into account cosmesis and the cutaneous incisions for tro- car insertion, the mobility of the visceras that must be anas- tomosed outside the abdominal cavity, and the easiest way in which the anastomosis can be accomplished. The mini- laparotomy incision is identified by bringing to the abdom- inal wall the bowel proposed for the site of the anastomo- sis. The patient, under general anesthesia, is positioned in a supine position with legs apart. The monitor and laparo- scopic instruments are placed behind his head, on the patient's right side. The operating surgeon is positioned between the legs of the patient, the second surgeon to the right of the operator, and the camera operator on his left (Figure 1). After induction of pneumoperitoneum 15 mm Hg, a 10 mm trocar is inserted in the upper midline, and a laparoscopic exploration of the abdomen performed in order to choose the most suitable procedure and position of the remaining trocars. Two 5/12 mm trocars are placed in the left and right iliac fossa, and a 5 mm trocar in the left flank, which makes a total of four trocars (Figure 2). The transverse colon is lifted and the region examined down to the ileal loop. The superior mesenteric artery is identified, and the posterior peritoneum incised on its salience. The ileocolic and right colic arteries are secured and dissected between clips or extracorporeal non-absorbable knots. The middle colic artery, last ileal loop and cecum are dissected and mobilized. The opening into the right parietocolic gutter is begun from the ileocecal valve and continued upward, remaining in the avascular fascia of Told. The ureter and the third segment of the duodenum is visualized. During this dissection, even if performed in an avascular plane, injury may occur to the iliac vessels. Bulky tumors and adhesions can hamper the correct definition of structures. The colon is retracted medially, and detachment from the right flexure completed. The distal ileal loop, after mobi- lization, is dissected with aid of a 30 mm intestinal stapler (Endo GIA 30 Auto Suture, U.S. Surgical Corp.), which can be used to divide the bowel and mesentery. The ileocolic segment and transverse colon are mobilized, delivering the protected specimen through a transverse muscle-splitting minilaparotomy incision in the right hypochondrium. An ileocolic, side-to-side extracorporeal anastomosis is per- formed with continuous monolayer suture, using a slow- absorption thread. After suturing the mesentery defect, the bowel is placed back into the peritoneal cavity and the pneumoperitoneum reinsufflated. The results of the pro- cedure are assessed laparoscopically, and, if necessary, suture of the mesentery completed. Most authors advise against performing the anastomosis intracorporeally, because of its long execution and avoidable technical diffi- culties. The operation is completed by positioning a non- aspirating drain in right parietocolic position, inserting it through the right iliac fossa trocar site. LEFT COLECTOMY The regions exposed during this operation are: 1) the infe- rior mesocolic region for ligature and dissection of the infe- rior colic vessels; 2) the pelvis; 3) the left parietocolic gut- ter; 4) the splenic flexure; 5) the pelvis, for execution of the anastomosis. The main drawback to these expositions arises from the small intestine, which must be moved with great calm, grasping it carefully with atraumatic forceps. The indispensable means of exposure is gravity. The patient is placed in a supine position, with legs apart, right arm folded, and the left arm extended. The patient must be secured to the operating table with shoulder and flank stirrups, so that he can be rotated through different positions during the procedure that will allow for exposure of the operative field. It is useful to have two monitors. However, if only one monitor is available it should be posi- tioned behind the patient's left foot. The monitor is moved behind the patient's left arm during exposure of the splenic flexure. Place the monitor on a mobile truck along with the insufflator, camera, and light source. Cables and tubes JSLS (1997) 1:217-224 219