Trocar placement for left/sigmoid colectomy and proctectomy

For laparoscopic left/sigmoid colectomy or proctectomy, trocars are placed in a baseball diamond configuration. In addition to the initial optical trocar placed above the umbilicus, one trocar is generally placed two fingerbreadths above the pubic tubercle in the midline, another two to three fingerbreadths away from and oblique to the left anterior superior iliac spine (ASIS), and the last a few fingerbreadths away from and oblique to the right ASIS. The right lower quadrant trocar is 12 mm to accommodate the endoscopic stapler; the rest of the trocars are typically 5-mm ones. Depending on body habitus, the positioning of the trocars may need to be altered, and more trocars may be required.