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Laparoscopic Soave Images

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Pre-op photo, 1-year old patient with Hirschsprung's disease and right lower quadrant colostomy.
VID 102, frame 1

hirP4001

 

Pre-op photo with overlaid sketch of colon.
VID 102, frame 1

hirP4002

 

Operating room layout.
VID 102, frame 2

hirG4003

 

Stoma sewn shut with 3-0 nylon purse string suture.
VID 102, frame 3

hirP4004

 

Digital rectal exam.
VID 102, frame 4

hirP4005

 

Circumferential prep allows patient to be rotated during procedure.
VID 102, frame 5

hirP4006

 

Laparoscopic port placement.
VID 102, frame 6

hirP4007

 

Surgeons in position for laparoscopic abdominal portion of procedure.
VID 102, frame 7

hirP4008

 

Laparoscopic view from right upper quadrant camera port shows end colostomy and rectal pouch.
VID 102, frame 8

hirG4009

 

Laparoscopic view from right upper quadrant camera port shows end colostomy and rectal pouch (labeled).
VID 102, frame 8

hirL4009

 

Colostomy dissected free from abdominal wall connections.
VID 102, frame 9

hirG4010

 

Colon transected just below stoma using Endo-GIA stapler.
VID 102, frame 10

hirG4012

 

Lateral attachments of left colon divided.
VID 102, frame 11

hirG4013

 

Colon mobilized sufficiently to reach deep inguinal ring without tension.
VID 102, frame 12

hirG4014

 

Rectal pouch mobilized and dissected circumferentially free of pelvic attachments.
VID 102, frame 13

hirG4015

 

Silk stay sutures placed at level of dentate line to evert anus.
VID 102, frame 14

hirP4016

 

Eversion of dentate line, cross-sectional view.
VID 102, frame 15

hirG4019

 

All stay sutures in place.
VID 102, frame 16

hirP4020

 

Rectal mucosa is marked with cautery above dentate line.
VID 102, frame 17

hirP4021

 

Saline injected submucosally.
VID 102, frame 18

hirP4022

 

Mucosa separated from submucosa using cautery.
VID 102, frame 19

hirP4023

 

Level of mucosal division, cross-sectional view.
VID 102, frame 20

hirG4024

 

Submucosal plane development complete. Mucosa stripped from muscle using fine-needle cautery and cotton-tipped applicators.
VID 102, frame 21

hirP4025

 

Eversion of mucosal sleeve, cross-sectional view.
VID 102, frame 22

hirG4026

 

Forceps placed down mucosal sleeve to aid dissection.
VID 102, frame 23

hirP4027

 

Dissection reaches peritoneal reflection.
VID 102, frame 24

hirP4028

 

Eversion of the denuded muscular wall of rectum, cross-sectional view.
VID 102, frame 25

hirG4029

 

Muscle edge grasped and opened with cautery.
VID 102, frame 26

hirP4030

 

Circumferential division of the rectal wall.
VID 102, frame 27

hirG4031

 

Removal of the mucosal sleeve and Hartman's pouch.
VID 102, frame 28

hirP4032

 

Colon pulled through opening, cross-sectional view in case without colostomy.
VID 102, frame 29

hirG4033

 

Mesentery divided, cross-sectional view in case without colostomy.
VID 102, frame 29

hirG4034

 

Remaining muscle sleeve after removal of distal mucosa and proximal colon.
VID 102, frame 30

hirP4035

 

Muscle sleeve split posteriorly with cautery.
VID 102, frame 31

hirG4037

 

Trochar introduced into abdomen through muscular rectal cuff.
VID 102, frame 32

hirP4038

 

Grasper passed.
VID 102, frame 33

hirP4039

 

Grasper passed through rectal cannula.
VID 102, frame 34

hirG4041

 

Stapled end of colon grasped, laparoscopic view.
VID 102, frame 35

hirG4043

 

Colon pulled through muscle sleeve, laparoscopic view.
VID 102, frame 35

hirG4044

 

Colon pulled through muscle sleeve, cross-sectional view.
VID 102, frame 36

hirG4046

 

Stapled end of colon visible at anal verge.
VID 102, frame 37

hirP4045

 

Staple line removed.
VID 102, frame 38

hirG4047

 

4-0 Vicryl sutures placed through full thickness of pulled-through colon.
VID 102, frame 39

hirP4048

 

Initial sutures placed at 12, 3, 6, and 9 o'clock.
VID 102, frame 40

hirG4049

 

After first four sutures placed, quadrants are filled in.
VID 102, frame 41

hirP4050

 

Completed neoanus.
VID 102, frame 42

hirP4051

 

Abdomen after closure of port sites and removal of stoma.
VID 102, frame 43

hirP4052

 

This page was last modified on 3/20/2000.
 

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