ferent signs and symptoms that may be associated with someone who must undergo a small bowel resection. Pain п‚Ў Internal bleeding п‚Ў Blockage may cause vomiting п‚Ў Polyps (seen by colonoscopy) п‚Ў Tumors found by MRI п‚Ў May be found during trauma п‚Ў п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё Atraumatic bowel graspers Laparoscopic scissors Harmonic scalpel Scalpel Suction device GIA endostapler 3 trocars (one 10mm and two 5mm) 30 degree scope Suture Various clamps and scissors Hand port (Optional) TA Stapler (Optional) On-Q painbuster (optional) вЂўPatient begins in supine position вЂўMove patient into positions later to allow gravity to shift unwanted organs out of the way. вЂўTwo screens to allow surgeons on both sides of patient to see вЂўAnthesiologist positioned behind patientвЂ™s head and scrub nurse positioned near the feet (not shown) п‚Ё п‚Ё One 10 mm trocar placed in umbilical incision for camera Two 5 mm trocars placed in abdomen to triangulate on area to be resected. Trocar placed in abdomen via the Opti-view This can be seen on the left going through the layers of the abdomen. Step 1: вЂўMove along bowel using atraumatic bowel graspers to find the source of the desired bowel for excision. вЂўNote from surgeonпѓ be sure to grab the fat near the bowel and not the bowel itself this will reduce the risk of tearing. вЂўBowel may have attachments so be sure to mobilize the bowel . This is important because the small bowel will be extracted from the abdomen. п‚Ё Step 2: п‚Ў п‚Ў After finding desired small bowel, use the harmonic scalpel to dissect mesentery and ligate the arteries of the Superior Mesenteric Artery If bleeding occurs suction may be used to remove interfering blood. Caution: The Harmonic Scalpel is very hot. Be sure not to damage internal structures by touching them with the tip after cutting. п‚Ё Step 3: п‚Ў п‚Ў Once vasculature has been minimized to desired area, remove the camera and trocar and lengthen the umbilical incision. This lengthening will allow for the small intestine to be removed from the abdominal cavity. вЂўA hand port may be used during this step of the procedure. If a hand port is used, the umbilical incision will be lengthened, the port placed, and then the intestine will be pulled from the abdomen. п‚Ё Step 4: Locate desired portion of bowel and using mosquito clamps, clamp around the edge of the area to be removed. п‚Ў Cut in between the two clamps. п‚Ў This procedure will be done on both sides of the intestine to be removed. п‚Ў п‚Ё Step 5: п‚Ў Perform a side-to-side anastamosis by aligning the two healthy small bowel segments side-by-side with the openings next to one another. The GIA endostapler may now be inserted into the openings and applied. This will anastamose the intestine leaving one opening at the end. п‚Ё Step 6: п‚Ў п‚Ў Close the opening of the anastamosis. Be sure to place other sutures around the anastamosis in order to reinforce the intestine. п‚Ё Step 7: п‚Ў Return bowel to abdomen through the umbilical incision. пѓє If desired, place On-Q Painbuster in patient. п‚Ё Step 8: Close incisions left over from trocars and umbilical incision. п‚Ё п‚Ё п‚Ё п‚Ё п‚Ё Hospitalization for 3-7 days. Ingestion of liquids is allowed by the second day. Slowly thicken liquid over time until solid foods may be ingested Pain and wound management The longer the length of bowel removed the longer the hospital stay and the longer one will be unable to eat solid foods. п‚Ё п‚Ё п‚Ё E., John, L. J., and Panajiotis N.. Minimally Invasive Surgical Procedures and Anatomy. Springer Verlag, 2005. 255-266. Print. http://www.nlm.nih.gov/medlineplus/ency/ article/002943.htm Smith, James, Abdominal Surgery v. 2., Bristol, 1897. 589-591. Digital Print.