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Vascular high ligation and embryological plane dissection in laparoscopic restorative proctocolectomy for ulcerative colitis – a video vignette

abscesses and autonomic nerve damage. This can be done by an intersphincteric transperineal approach, avoiding an abdominal procedure [3]. If a uniquely perineal approach is not possible (e.g. in the case of a preexisting ileorectal anastomosis), an abdominal single port can be added. In 2012 a 40-year-old woman with an American Society of Anesthesiologists score of 2 and body mass index of 20 kg/m underwent a laparoscopic subtotal colectomy with ileorectal anastomosis and loop ileostomy for complicated Crohn’s colitis with perianal disease. Later, despite maximal therapy and diversion, rectal fistulating disease worsened and a completion proctectomy and definitive ileostomy was agreed upon. A combined abdominal and transanal procedure was planned. The perineal phase consisted of dissection in the intersphincteric plane to the pelvic floor with detachment of an anovaginal fistula, induction of a pneumorectum through a single-port device (GelPOINT Path, Applied Medical, Rancho Santa Margarita, California, USA) and close-rectal dissection carried distally to the peritoneal reflection. Synchronously, the loop ileostomy was closed and a single-port (GelPOINT) pneumoperitoneum was established. After dividing the adhesions, resection of the ileorectal anastomosis was performed and a terminal ileostomy was created. The patient was discharged 5 days after the procedure following an uneventful recovery.