After the port, a 5 mm 30 degree scope was advanced and under direct visual guidance, a right lower quadrant 12 mm port was positioned and a right upper quadrant 5 mm port placed. With all of these ports now in position, the patient was rotated
to the right. The adhesions of the sigmoid colon were sharply divided. The
colon was mobilized into the retroperitoneum. It was then sufficiently lax
that it approached the abdominal wall quite easily. At this point, spinal
needle confirmed the location of the lateral rectus border or the lateral
aspect rectus compartment. At this point, the skin and subcutaneous tissue was
resected down to fascia. A longitudinal incision in the anterior rectus sheath
completed. The posterior rectus sheath entered. The colostomy was brought
through this. Approximately 4.5 to 5 cm diameter incision with the loop
brought up. A bar was placed underneath the colostomy and sutured in position.