1. The Next Era in GI Surgery BioDynamix TM Anastomosis The Colon Ring Clinical Training Team TREATMENT Surgical Procedures

6. Hartman Procedure In performing a Hartman procedure, the pathologic specimen is resected, and an end sigmoid colostomy is created, leaving a rectal pouch for later closure.

8. Coloanal Anastomosis – Hand-sewn The anastomosis in this case is hand-sewn.

10. Abdominoperineal Resection No anastomosis is performed—there is an end sigmoid colostomy with removal of the rest of the rectum and anus with perineal closure.

11. Abdominoperineal Resection (APR)

16. Sigmoidectomy

20. Procedures—Low Anterior Resection Many surgeons will not specifically distinguish between Anterior and Low Anterior Resection. For our purposes, we will consider any anastomosis below 8 cm from the anal verge to be a Low Anterior Resection (anastomosis).

21. Low Anterior Resection with TME Anterior resection with total mesorectal excision (TME) is the optimal treatment for low rectal cancer, except where the tumor is close to or involving the anal sphincter complex.

22. Low Anterior Resection with TME Mobilization of the left colon and the rectum is usually required. An anastomosis between the descending colon and the rectum is performed.

25. Hartman Reversal/Closure There are several special considerations with this procedure.

28. Total Colectomy w/Ileoproctostomy Anvil placement in the small bowel requires special considerations due to the often decreased diameter of the ileum to <27 mm.

29. Procedures—Ileal Anvil Placement

30. Total Colectomy w/Ileoproctostomy Anvil placement in the small bowel should be brought out the side of the ileum about 5 cm proximal to the end in order to avoid the potential for radial tension should the diameter of the ileum be <27 mm, either due to normal small lumen or subsequent spasm.

33. Proctocolectomy w/Ileoanal J-Pouch

34. Procedures—Ileoanal J-Pouch

37. Procedures – Coloanal J-Pouch

38. Procedures – Coloplasty A longitudinal incision is made along the tenia. The longitudinal incision is closed transversely, enlarging the transverse diameter and creating a small pouch. Longitudinal incision Incision closed transversely Pouch

39. Protective, Diverting or Loop Ileostomy

41. Right Hemicolectomy

47. Procedures—Ileal Anvil Placement

54. Transverse Colectomy The proximal segment is usually anastomosed end-to-end or side-to-side to the distal segment.

55. High Left Colectomy/Hemicolectomy The proximal segment is usually anastomosed end-to-end or side-to-side to the distal segment.