A standardized technique for laparoscopic total colectomy in acute severe ulcerative colitis: a technical note

Ulcerative colitis (UC) often necessitates total colectomy in cases of medically refractory disease or complications, with over one-third of patients undergoing surgery despite advances in medical therapy. Standardization in colectomy techniques is crucial to improving surgical outcomes, enhancing reproducibility, and addressing variability in practices. This study revisits laparoscopic total colectomy, emphasizing a "critical view of safety" approach to streamline the procedure, reduce anatomical disorientation, and overcome steep learning curves for trainees. The proposed technique divides the procedure into two phases: left colectomy and right/transverse colectomy, each featuring five standardized critical views. These views provide a clear framework for key anatomical landmarks, including the pancreas, splenic hilum, Gerota's fascia, and middle colic vessels. Patient positioning and trocar placement are also standardized to ensure procedural consistency. The adoption of this refined, minimally invasive approach aligns with ECCO guidelines, offering advantages, such as fewer perioperative complications, shorter hospital stays, and preserved fertility. This method minimizes inter-surgeon variability, facilitating reproducibility in elective and emergency settings. Collaborative multi-disciplinary care among surgeons, gastroenterologists, and specialized nurses further supports timely surgical decision-making and improved post-operative outcomes.