Design: Educational Surgical Video.

Setting: Academic-affiliated medical center outpatient surgical center.

Patients or Participants: Patients undergoing laparoscopic pelvic surgery for benign gynecologic indications with history of bowel resection and temporary or permanent stoma in place. A case is presented of a 27 year old female with history of procto-colectomy with diverting ileostomy present who underwent a laparoscopic bilateral ovarian cystectomy.

Interventions: This educational video demonstrates the anatomic and lifestyle considerations taken into account when a stoma site is selected. Strategic selection of initial laparoscopic entry site is shown depending on the site of the stoma as well as appropriate placement for subsequent accessory trocars. A surgical case is shown as an example of how to approach laparoscopic surgery for a patient with a stoma.

Measurements and Main Results: N/A

Conclusion: Previous bowel surgery and ostomy is not a contraindication to minimally invasive gynecologic surgery. Surgeons should utilize their preferred initial entry technique in patients with stoma, as no single entry technique has been shown to be safer than any other. However, initial entry location should be determined by not only a patient’s surgical history but also by stoma site. Accessory ports should be determined by intra-abdominal adhesions and location of the target pathology. Minimally invasive approach to colorectal surgery and ostomy creation improves the safety of future re-operation if needed.