Laparoscopy offers favorable postoperative course and smaller incision for patients undergoing total colectomy. Mobilization of the transverse colon (TC) and ligation of the middle colic (MC) vessels are usually the most difficult and technically demanding parts of laparoscopic total colectomy.

The video presents a 31 year old male who underwent restorative proctocolectomy for refractory ulcerative colitis. It focuses on pure laparoscopic technique for TC mobilization.

The operation starts with right and left colon mobilization. Vascular pedicles are divided first and then a medial to lateral posterior dissection is performed followed by incision of lateral attachments. The hepatic and splenic flexures are mobilized starting laterally and proceeding as far medially as possible.

The gastrocolic omentum is opened to enter the lesser sac and then divided transversely in both directions to complete hepatic and splenic flexure mobilization. The MC vessels are approached from both above and below the transverse mesocolon, then isolated and ligated. The remaining transverse mesocolon is transected. Pelvic dissection, specimen removal through a mini laparotomy and ileoanal pouch construction complete the procedure.

A stepwise standardized approach to TC mobilization facilitates the use of pure laparoscopic technique in this challenging procedure.