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In the earliest report of laparoscopic colon resections in 1991, Jacobs, Florida, described his initial experience with Ćlaparoscopic-assistedĆ colon resection in 20 patients. In the past 15 years, thousands of colorectal resections have been performed all over the world. Skillful surgeons have consistently introduced new surgical techniques with excellent outcomes and thus motivated their colleagues to use these techniques in their patients. As a result laparoscopic resection has been adopted to treat conditions of all parts of the large intestine. This paper deals with left hemicolectomy and sigmoidectomy. These procedures can be regarded as technically most challenging surgical laparoscopic operations. Several techniques have been described for mobilizing and resecting the splenic flexure, descending colon, sigmoid, and rectum. We present our method with the aim to contribute to further development of laparoscopic colorectal surgery. Surgical strategies and techniques used in left hemicolectomy and sigmoidectomy are described and oncologically relevant aspects are considered. Between April 1996 and December2008, approx. 680 patients were treated by laparoscopic left hemicolectomy and sigmoidectomy using a standardised four-trocar laparoscopic surgical technique, described in this paper. The indications for surgery ranged from benign diseases to malignant conditions.

Removal of both benign and malignant lesions of the distal ileum, cecum, ascending colon and hepatic flexures can be managed by right colectomy. This article focuses upon the technical issues of laparoscopic right colonic resection, which involves complete mobilization of the terminal ileum and right colon to the level of midportion of the transverse colon. Patient preparation for laparoscopic right colectomy is identical to that used for theopen procedure and the patient is placed in a normal or lithotomy position.Insertion of three of the four trocars used depends on the patientćs body habitus, type of resection and operative findings. Vascular isolation done through the windows in the mesocolon is recommended before colon mobilization. A harmonic scalpel is used for ileocolic mobilization to provideimproved haemostasis. Retraction is facilitated by using the companion port, thereby allowing the surgeon to use a two-handed technique. After the entire colon has been mobilized, vascular ligation and anastomis are made extacorporeally for the laparoscopic-assisted technique. Extension of the umbilical incision and entrance into the peritoneal cavity is facilitated by incising along the shaft of the trocar. Application of a small drape for woundprotection is manadatory before withdrawing the port, grasper and cecum as one unit. The rest of the specimen is removed, and there follows safe and rapid division of the vascular supply and bowel anastomosis outside the peritoneal cavity. Currently, the laparoscopic-assisted method is favoured over the total intracorporeal approach because the latter is more technically demanding and time-consuming, less cost-effective and less safe, and carries an increased risk of contamination. Z desno hemikolektomijo lahko odstranimo benigne in maligne spremembe distalnega ileuma, cekuma, ascendentnega kolona in hepatične fleksure. V prispevku je prikazana tehnična izvedbanlaparoskopske resekcije desnega kolonaz mobilizacijo terminalnega ileuma in desnega kolona do sredine prečnegakolona. Priprava bolnika za laparoskopsko desno hemikolektomijo je enaka kot za odprto operacijo. Bolnik je na operacijski mizi v normalnem ali litotomijskem položaju. Tri do štiri troakarje uvedemo na mestih, ki so odvisna od bolnikove konstitucije, vrste resekcije in najdbe pri operaciji. Pred mobilizacijo kolona je priporočljivo izolirati žile preko okna, narejenega v mezokolon. Uporaba harmoničnega skalpela pri ileokolični mobilizaciji pripomore k izboljšani hemostazi. Retrakcijo olajšamo z uporabo dodatnega troakarja, tako da kirurg lahko uporablja obe roki. Ko je kolon mobiliziran, se pri laparoskopsko asistirani operaciji žile ligirajo in pa se naredi anastomoza zunajtelesno. Povečanje incizije umbilikalno in vstop v peritonealno votlino je olajšan z rezom ob troakarju. Preden hkratni izvlečemotroakar, prijemalke in cekum je treba zaščititi operativno rano. Natoodstranimo še ostali del preparata, prekinemo žilno preskrbo in naredimo anastomozo zunaj peritonealne votline. Laparoskopsko asistirana metoda ima prednost pred popolnim znotrajtelesnim posegom, ker je ta poseg tehnično zahtevnejši, traja dalj časa, je dražji, manj varen, poveča pa se tudi možnostokužbe.

Since the introduction of video-laparoscopy in the mid-'80s almost all general surgery standard surgeries in specialized centres have been performed laparoscopically. Some of the interventions like the laparoscopic reflux surgery, the cholecystectomy and minimally invasive hernia surgery have more or less completely replaced the conventional method. For systematic reasons and due to the huge number of diseases, only a few examples were chosen.

The role of laparoscopic colon resection is still an object of many debates, specially for treatment of malignant diseases. Laparoscopic surgery is accepted as a first choice of treatment for benign diseases as well as for palliative treatment in advanced malignant diseases. We performed the first laparoscopic colon resection on December 12th 2002. Since then we have performed 34 operations. The cost of laparoscopic colon resection is comparable with open colon surgery. Considering our short experience and literature data, we can conclude that laparoscopic colon resection is comparable with open colon resection, including malignant disease treatment., {"references":["Tittel A, Schumpelick V. Laparoskopische Chirurgie: Erwartungen und Realität. Chirurg 2001; 72: 227- 35.","Baća, I, Götzen V, Petričević M, Petričević A. Laparoscopy- Assisted Colorectal Surgery. Croat Med J 1996; 37 (3) 169-73.","Jacobs M, Verdeja JC, Goldstein HS. 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