Laparoscopic Sigmoid Resection for Diverticulitis
Derek J. Erstad, MD; David Berger, MD
Massachusetts General Hospital

Laparoscopic sigmoid resection is indicated for disease of the distal sigmoid or rectum that requires resection, most notably diverticulitis and colorectal cancer. Here, we perform a sigmoid resection for diverticular disease. In this procedure, we used four laparoscopic port sites.

In the first step, we mobilized the splenic flexure and left colon to allow for a tension-free colorectal anastomosis low in the pelvis. Second, the mesorectum was dissected to mobilize the rectum down to the level of the pelvic floor. Third, the left colic and inferior mesenteric arteries were ligated, the colonic mesentery was transected with an energy device, and the distal resection margin was stapled intracorporeally. Fourth, the specimen was extracorporealized through the umbilical port site, and the proximal transection was performed. Finally, an anvil was inserted, and the colon was placed back into the abdomen where a trans-anal, stapled end-to-side Baker-type anastomosis was performed and endoscopically tested for leaks.