A 66 year old man presents with two hospital admissions in the previous two months for diverticulitis. Radiologic investigations including barium enema and CT scan showed a right lower quadrant abscess not amenable to percutaneous drainage.

The video demonstrates the technique of laparoscopic left colectomy for treatment of diverticular abscess with takedown of the splenic flexure using a three trocar technique.

I. Positioning of the trocar placement: The patient was placed in a modified Y lithotomy position and then, under general endotracheal tube anesthesia, three 12 mm trocars were placed as such: (a.) camera port - supraumbilical position, (b.) working port - right lower quandrant, lateral to the rectus abdominus at the level of umbilicus (c.) suprapubic port - midline.

II. Surgical Technique: The video highlights the following steps of the procedure:

1. Takedown of the splenic flexure: A harmonic scalpel is used to divide the gastrocolic and splenic ligaments taking care to avoid thermal injury to the bowel.
2. Positioning of the small bowel: Steep Trendelenberg and airplaning of the table are used to place the small bowel such that access is granted to the pelvis.
3. Transection of the IMA/IMV: As the abscess is at the level of usual dissection of IMA near the sacral promontary, mesentery is divided starting superiorly and IMA is transected using a vascular stapler.Dissection of abscess cavity.
4. Mobilization of the colon: Dissection occurs laterally at the line of Toldt with the harmonic scalpel opening the left pararectal sulcus below the promontory.
5. Transection of the mesorectum: The presacral space is entered and the mesorectum is transected across at the level of the upper rectum.
6. Transection of the rectum: A GIA stapler is utilized to transect the rectum.
7. Removal of the specimen: A wound protector is placed and the colon removed.
8. Anastomosis: The colorectal anastomosis is created using an EEA stapler and tested with rectal insufflation.
9. Closure

This video demonstrates the technique of a laparoscopic left colectomy for treatment of diverticular abscess using a three trocar technique.