Primary Vascular Control

• For the initial procedure steps 1-3 (on the left patient side), the da Vinci System is used in a 4-arm set-up with instrument arms 1, 2 and 3 docked.
• Primary vascular control is achieved by dividing the inferior mesentery artery (IMA) first, then the inferior mesenteric vein (IMV), or vice versa based on surgeon’s preference. Anatomical overview and arm set up shown below.

1. Initial Exposure
2. Primary Vascular Control
3. Medial to Lateral Mobilization of Sigmoid & Descending Colon
4. Splenic Flexure Mobilization
5. Rectal Dissection & Division
• Posterior Dissection
• Lateral Dissection
• Anterior Dissection
• Rectal Division