Laparoscopic Colectomy: the Absolute Need for a Standard Operative Technique, Croce E. Figure 1. Position of patient and surgical unit during laparoscopic right hemicolectomy (S=sur- geon; A=assistant; N=nurse). Figure 2. Trocar sites in laparoscopic right hemi- colectomy. bowel is to be delivered with wall protectors, such as a 20- 25 cm piece of transparent plastic bag used to cover the camera. When the neoplastic segment is inside this plastic tube, it is important to exteriorize it together with its bag, avoiding any contact with the abdominal wall. Also segre- gated are segments of the bowel that must be kept and that could "collect" tumoral cell inside the plastic bag. We distinguish three kinds of laparoscopic colectomy: 1) Complete laparoscopic resections: when mobilization, ligation of the vessels and anastomosis are completed inside the peritoneal cavity and the specimen is removed through a minilaparotomy incision or transanally. 2) Laparoscopic assisted resections: when the bowel resection and the anastomosis are performed outside the peritoneal cavity through a small muscle-splitting incision of the abdominal wall. Mobilization, ligation of the vessels, and bowel dissection are completed inside the peritoneal cavity. 3) Laparoscopic facilitated resections: when laparoscopy is used only to mobilize the bowel; a small laparotomy is necessary to complete the procedure. Figure 3. Position of patient and surgical unit during laparoscopic left hemicolectomy (S=sur- geon; A=assistant; N=nurse). The most frequent operations for curative resection of col- orectal carcinoma are: right hemicolectomy, left hemi- colectomy, transverse resection, resection of the rectum uti- lizing the Miles procedure (for neoplasias less than 6 cm Figure 4. Trocar sites in from the anocutaneous rim), and anterior rectocolonic laparoscopic left hemicolec- resections. tomy. Figure 5. Position of patient and surgical unit during laparoscopic abdominoperineal resec- tion (S=surgeon; A=assis- tant;N=nurse). Figure 6. Trocar sites in laparoscopic abdominoperineal resection. 218 JSLS (1997)1:217-224 MATERIALS AND METHODS From April 1992to December 1996 we performed laparo- scopic colon surgery on 158 non-selected patients; 66 males and 92 females, with an average age of 66.7years (range 31-92). One hundred and thirty-four patients (84.9%) were operated on for adenocarcinoma, and the remaining 24 (14.1%) for benign disease (1 cecal angiodysplasia, 1 rectal prolapse, 1 rectosigmoid endometriosis stenosis, 2 reversal of Hartmann's procedures, 13 sigmoid diverticulitis, 6 ade- nomas that could not be removed endoscopically). All patients underwent complete blood tests (including CEA in neoplastic patients), thorax X-ray and EKG. More spe- cific examinations included barium enema (necessary for a morphologic study of the colon), colonoscopy, and, subse- quently, echographia, abdominal and pelvic CT scan in the case of neoplastic pathology. The patients were placed on a clear liquid diet two days before surgery, and given a dose of magnesium sulfate the day before surgery to expel any fecal residue. Patients received third-generation cephalosporin antibiotic, intravenously or intramuscularly, during pre-anaesthesia, 4 and 12 hours after the procedure.