Laparoscopic right hemicolectomy in left lateral decubitus position

The laparoscopic surgeon does not have the luxury of manually retracting small-bowel loops during right colonic mobilization and transection. Intraoperative rotation of the table aids gravity-produced displacement of small-bowel loops but is limited because extreme rotation endangers the patient's positional stability. By placing the patient in left lateral decubitus position before sterile draping, gravity-aided displacement of small-bowel loops can be maximized, facilitating safe and swift laparoscopic right colonic dissection and transection. Unlike the supine position, the left lateral decubitus position also permits transoperative colonoscopy, which may be needed to aid laparoscopic identification of nonpalpable intraluminal colonic lesions. Experience with four patients is reported.