Problem:
A 52-year-old female presented with abdominal pain and change in bowel habits. A barium enema suggested a diverticular stricture, so a sigmoidoscopy was performed in the clinic, finding a stricture at 25 cm. The patient was then scheduled for exploratory laparoscopy in the hospital outpatient surgical center to treat the stricture. Preoperative Diagnosis: Stricture of the sigmoid colon, rule out carcinoma Postoperative Diagnosis: Carcinoma of the sigmoid with invasion into adjacent tissue and suspected metastasis to the liver The patient was brought to the surgical suite, and an NG tube was placed in the stomach and a Foley catheter in the bladder. She was placed in the lithotomy position and routine prep and draping were performed. A small incision was made in the right upper quadrant directly into the peritoneal cavity with CO2. Once we had a good tent, we examined the peritoneal cavity and could not really see the liver because we were too close to it, but one view suggested surface lesions. After placement of the three cannulas (12 mm in the RUQ, 10 mm LLQ, and 5 mm in LUQ), we mobilized the sigmoid off the pelvic gutter and dissected down towards the bladder. She had undergone