Techniques in Coloproctology

, Volume 21, Issue 8, pp 673–677 | Cite as

Three steps and a join: a simple guide to right- and left-sided medial to lateral laparoscopic colorectal surgery

  • M. J. F. X. Rickard
  • A. Keshava
  • J. W. T. TohEmail author
Multimedia Article



To provide a standardised ‘medial to lateral’ approach to laparoscopic colorectal surgery.


Both right- and left- sided laparoscopic colorectal procedures were simplified into three well-defined steps and a join. An instructional video and procedural guide provides the important pearls and pitfalls in performing laparoscopic colorectal surgery.


During a 10-year period (2006–2016) at a single institution, 20 senior colorectal trainee surgeons and 20 general surgery registrars were trained in the ‘three steps and a join’ technique. Five hundred and sixty-eight laparoscopic anterior resections using this technique were performed. There were 5 (0.9%) leaks. Five hundred and forty-three laparoscopic right-sided resections were performed. There were 3 (0.6%) anastomotic leaks requiring reoperation and loop ileostomy.


This step-by-step instructional video and procedural guide provides a simple and standardised approach which may be incorporated into a training pathway for laparoscopic right- and left-sided colorectal surgery.


Laparoscopic colectomy Colorectal surgery Laparoscopic anterior resection Laparoscopic right hemicolectomy Laparoscopic ileocolic resection Medial to lateral 



The authors would like to thank Daisy Guo for her assistance with technical editing of the video.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The present paper was written according to an appropriate ethical standard.

Informed consent

No identifiable patient data has been included in this study.

Supplementary material

Supplementary material 1 (MOV 384547 kb)


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • M. J. F. X. Rickard
    • 1
    • 2
  • A. Keshava
    • 1
    • 2
  • J. W. T. Toh
    • 1
    • 3
    Email author
  1. 1.Colorectal Division, Department of SurgeryConcord HospitalConcordAustralia
  2. 2.Department of SurgeryMacquarie University HospitalMacquarieAustralia
  3. 3.Colorectal Division, Department of SurgeryWestmead HospitalWestmeadAustralia

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