LAPAROSCOPIC RIGHT HEMICOLECTOMY IN LEFT LATERAL DECUBITUS POSITION

The laparoscopic surgeon does not have the luxury of manually retracti ng small-bower loops during right colonic mobilization and transection . Intraoperative rotation of the table aids gravity-produced displacem ent of small-bower loops but is limited because extreme rotation endan gers the patient's positional stability. By placing the patient in lef t lateral decubitus position before sterile draping, gravity-aided dis placement of small-bower loops can be maximized, facilitating safe and swift laparoscopic right colonic dissection and transection. Unlike t he supine position, the left lateral decubitus position also permits t ransoperative colonoscopy, which may be needed to aid laparoscopic ide ntification of nonpalpable intraluminal colonic lesions. Experience wi th four patients is reported.