Laparoscopic IPAA

Options include:
- open laparotomy
- Lap assisted: mobilize colon laparoscopically and use low phannenstiel incision for extraction and creation of pouch
- Hand-assisted procedure
- completely laparoscopic - extraction site through ileostomy site (need normal BMI)
- single incision:

5 step Lap Total Colectomy - IPAA:
- mobilize left colon
- mobilize right colon - preserve ileocolic vessels for pouch
- rectal dissection: - uterus suspended with suture and sponge stick in vagina
- exteriorization of colon through ileostomy site: pt must be thin, bowel must be prepped
- anastamosis

Dr. Marks steps:
- takes infra colic
- takes ileo-colic vessels and divides ileum early so by end of case has sense of blood supply
- mobilize right colon
- middle colic division (branches ~3.5cm from take-off of SMA)
- divide omentum/supracolic dissection
- Closckwise rotation of cecum upto LUQ - allows you to follow the mesentery down to rectum
- pelvic dissection
- uses 30mm stapler coming vertically from supra pubic port site

Gaining length on SMA. 
- fenestrate SB mesentery