Laparoscopic left colectomy after symptomatic constipation in a patient with previous rectopexy for rectal prolapse

Background: Single incision laparoscopic left hemicolectomy is a feasible procedure. A suprapubic access allows to offer satisfactory cosmetic results in case of an extended scar due to a large tumor. An intracorporeal circular mechanical anastomosis is the most common type. A manual anastomosis is feasible and allows to control lumen opening, potential bleeding, and overall to overcome the difficulty of transanal stapler insertion in case of high rectal transection.
Video: This video shows two different types of manual colorectal anastomosis, through a right suprapubic access.
1) Double-layer end-to-end
2) Monolayer end-to-end
Results: After an appropriate learning curve, time to perform the manual anastomosis is 40 minutes.
Conclusions: Different colorectal anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire left hemicolectomy, please click here.

This video presents the case of a 62-year old Chinese woman with descending colon carcinoma. Preoperative histological exam through endoscopy revealed an adenocarcinoma.
The patient underwent a laparoscopic left hemicolectomy, using a medial to lateral approach. This technique allows for precise dissection, early identification of the inferior mesenteric artery, and identification of the left ureter through virgin planes.
The surgery was performed smoothly. Operative time was 3 hours 45 min, with a total blood loss of less than 100mL.
She was discharged on postoperative day 3 and final histology was pT3N0 (0 out of 19 lymph nodes).

To achieve a safe tension-free anastomosis during a laparoscopic left colonic resection, complete splenic flexure mobilization is mandatory. In this live interactive surgery, Dr. Salvador Morales-Conde performed a laparoscopic left colectomy with complete splenic flexure mobilization for diverticular disease showing his technical tips in each surgical step.

The laparoscopic approach to colonic cancer will replace open surgery in the majority of cases. In this key lecture, Professor Okuda provides some tips and tricks to perform a total laparoscopic approach for right and left colectomy.

In this key lecture, Dr. Armando Melani focuses on left colectomy for cancer.