The article "Treating benign colon ...

The article "Treating benign colon disorders using laparoscopic colectomy," is the basis for this AORN Journal independent reflection The behavioral objectives and examination for this program were prepared according to Helen Starbuck Pashley, RN, MA, CNOR, contributing editor, with consultation from Eileen J Ullmann, RN MH CNOR, professional education specialist, Center for Perioperative Education.

A minimum score of 70% forward the multiple-choice examination is necessary to earn 3 contact hours for this independent inquiry Participants receive feedback on incorrect answers. Each applicant who fortunately completes this study will receive a certificate of completion. The deadline for submitting this contemplation is Feb 29, 2004.

despatch the completed application form, multiple-choice examination, learner evaluation, and appropriate give a fee to to

AORN Customer Service c/o hearth Study Program 2170 S Parker Rd Suite 300 Denver CO 80231-5711

Or fax the information with a credit card number to (303) 750-3212

BEHAVIORAL OBJECTIVES

After reading and studying the article onward treating benign colon disorders using laparoscopic colectomy, the suckle will be able to

(1) describe the anatomy of the bowel,

(2) discuss the pathophysiology of the bowel as it relates to benign colon disorders,

(3) discuss the treatment of benign colon disorders, and

(4) describe the perioperative care of the patient undergoing laparoscopic colectomy.

This program propers criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

Laparoscopically assisted bowel surgery is a newly come application of minimally invasive video-scopic techniques. grave anterior colon resection and right colectomy are brace laparoscopic approaches to treat benign bowel disease. The laparoscopic approach to colectomy has been explored since 1991 and shows patients less perioperative morbidity, a shorter hospital stay, faster go [i]or[/i] come back to work, and better cosmesis than previous techniques.[1]

BOWEL ANATOMY

The alimentary canal comprises a series of organs that form a tube-like texture that extends the entire fulness of the trunk. The alimentary tract includes the

* mouth;

* pharynx;

* esophagus;

* stomach;

* small intestine, which comprises the duodenum jejunum and ileum; and

* the large intestine, which comprises the cecum ascending colon transverse colon descending colon sigmoid colon rectum and anus (Figure 1)

[Figure 1 ILLUSTRATION OMITTED]

These organs are responsible for supplying nourishment to the dead body and eliminating solid wastes.

The large intestine begins at the ileocecal valve and terminates at the anus. It is divided into the cecum colon and rectum The cecum is attached to the ileum and lengthen outs approximately two and one-half inches below it. The cecum in an adult usually is adherent to the posterior wall of the peritoneal cavity and has a serosal covering in succession its anterior wall only. The cecum forms a blind bag from which the appendix projects

Colon The colon is divided into four parts: the ascending colon the transverse colon the descending colon and the sigmoid colon

Ascending colon The ascending colon is approximately six inches extended and extends upward from the ileocecal valve to the hepatic bend The upper portion of the ascending colon lies behind the right lobe of the liver and in head of the anterior surface of the right kidney.

Transverse colon The transverse colon which is approximately 20 inches lengthy begins at the hepatic fold and ends at the splenic bend It lies below the stomach and is attached to the transverse mesocolon

Descending colon The descending colon dilates downward from the splenic mode of bending to the area just below the iliac device and is approximately seven inches prolonged The iliac portion of the sigmoid colon approximately six inches prolonged lies on the inner surface of the left iliac muscle.

Sigmoid colon The remaining portion of the colon passes above the pelvic rim into the pelvic cavity and lies partly in the abdomen and partly in the pelvis. It then forms an S-curve in the pelvis and terminates in the rectum at the horizontal of the third segment of the sacral vertebrae.

The wall of the colon is made up of taeniae coli, epiploic appendices, and haustra. The taeniae coli are three longitudinal, or axial, strips of muscles distributed around the circumference of the colon They portray the longitudinal muscle layer, which is not integral in the colon. The epiploic appendices are fatty appendages along the bowel that have no particular function; the haustra are sacculations that are the outpouchings of bowel wall between the taeniae coli. The diameter of the colon varies from approximately three and one-half inches in the cecum to an average of one-half inch in the sigmoid colon The rectum originates at the sigmoid colon and terminates at the anus.[2]

During laparoscopy, insufflation of the abdomen impels the abdominal wall away from the intra-abdominal peaces With the laparoscope, the liver, stomach, duodenum small bowel, and entire colon excluding the rectum can be seen The right ureter and testicular or ovarian utensils can be seen when the surgeon medially thinks the right colon. Medial reflection of the sigmoid colon show in one's real lights the left ureter and testicular or ovarian ducts The pelvic organs in a female are seen easily after the surgeon retracts the small bowel superiorly. The bladder can be seen in the anterior lower midline of the pelvis in the pair sexes.