At mean follow up of 36 months global cancer related survival is 85%.Ĭonclusion: With the technique shown a complete laparoscopic take down of the splenic flexure is performed, allowing a tension free anastomosis and the retrievement of an oncologically adequate specimen through a low minilaparotomy.
Thirteen (5.6%) symptomatic leaks occurred in left colectomies and 19 (10.5%) in anterior resections. The left branch of middle colic artery was ligated and divided as well as. The great omentum was divided using Harmonic scalpel and its left part was removed en bloc with the splenic flexure. Mean operative time was 228±58 minutes for left colectomies and 284☗8 minutes for low anterior resections number of lymphnodes retrieved was 13☗, length of specimen 27☑4 cm. Division of splenocolic and gastrocolic ligaments from left to right completed splenic flexure mobilization releasing the distal third of transverse colon. This adds in a later, tension free anastomosis. Results: Out of 579 laparoscopic elective colorectal resections for cancer, 234 were for left colon cancers and 181 for rectal cancers. + 44139 Mobilization (takedown) of splenic flexure with parti ltial coltlectomy (use in conjunction with 4414044147) Attachments are dissected free and taken down to freely move the colon. The inferior mesenteric vein is divided the mesentery of the left colon is detached from the Gerota a hole is made in the mesentery of the transverse colon above the pancreas allowing the gas to enter the lesser sac the mesentery of the flexure is detached from the pancreas in a mediolateral direction the colon is detached from the omentum and the left abdominal gutter and the flexure mobilised. The key landmark for this approach is the inferior mesenteric vein (IMV) which is found next. This is a 64 year old gentleman with two synchronous lesion in the sigmoid colon, one proximally and one distally as shown by the two tattoed areas. Salvador Morales-Conde performed a laparoscopic left colectomy with complete splenic flexure mobilization for diverticular disease showing his technical tips in each surgical step. In this video we show our technique for splenic flexure mobilization via a medial to lateral approach.
Methods: The patient is in Trendelemburg position, rotated to the right. To achieve a safe tension-free anastomosis during a laparoscopic left colonic resection, complete splenic flexure mobilization is mandatory. It allows a tension-free anastomosis and a proper exteriorisation of the specimen with the ligated origins of the inferior mesenteric vessels through a minilaparotomy located in the lower abdomen. Introduction: Take down of the splenic flexure is a crucial part of laparoscopic anterior resection.
0 kommentar(er)
