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surgical intervention video

实时交互式手术：大肠脾曲动员


Splenic flexure mobilization is technically challenging. However, it is necessary to achieve a tension-free anastomosis for any low rectal cancer resections or for a shortened sigmoid colon. In this live interactive surgical video, Dr. Armando Melani (Brazil) demonstrates a medial-to-lateral approach to splenic flexure mobilization for laparoscopic low anterior resection. He defines the main points of his procedure in a stepwise approach and provides technical tips to facilitate exposure and prevent any potential risks of splenic or vascular injuries.

LIVE INTERACTIVE SURGERY: colorectal splenic flexure mobilization

CIRURGIA INTERATIVA AO VIVO: mobilização colorretal da flexura esplênica


CHIRURGIE LIVE INTERACTIVE: mobilisation colorectale de l'angle colique gauche 


LIVE хирургия: мобилизация селезёночного изгиба ободочной кишки

CIRUGÍA INTERACTIVA EN VIVO: mobilización colorrectal de la flexura esplénica


Background: The mobilization of the splenic flexure during laparoscopic colorectal surgery can be a challenge, especially in anatomically difficult patients. In this video, the inframesocolic, the supramesocolic, and lateral-to-medial approaches are demonstrated. 

 

Video: The first part of the video shows the inframesocolic approach where the opening of the transverse mesocolon, above the pancreatic body and tail, allows access to the lesser sac and the exposure of the spleen. The second part of the video shows the supramesocolic approach where reaching Gerota’s fascia allows the flexure to be taken down. The third part of the video shows the lateral-to-medial approach where opening the lesser sac allows the flexure to be mobilized. 

 

Results: All three approaches are laparoscopically feasible and safe. The goal remains similar, that is to avoid anastomotic tension. The operative time for this step, during the entire colorectal procedure, is influenced by the patient’s characteristics (previous surgery, high splenic flexure, short mesentery, etc.) and obviously, by the surgeon’s learning curve. 

 

Conclusions: The choice between the three approaches depends on the patient’s characteristics and on the surgeon’s habits.

The 3 approaches to splenic flexure mobilization

3种方法以脾曲动员


As três abordagens para a mobilização da flexura esplênica


3 методики мобилизации селезеночного изгиба ободочной кишки


Les 3 voies d'abord pour mobiliser l'angle colique gauche


Los tres abordajes para la mobilización de la flexura esplénica


This film demonstrates an oncologic colon resection in a 36-year-old male patient presenting with an adenocarcinoma of the splenic flexure. This operation was performed using a medial-to-lateral mesocolic excision approach and an intracorporeal anastomosis technique. 

Laparoscopic left hemicolectomy for splenic flexure adenocarcinoma (from medial to lateral approach)

Hemicolectomia esquerda laparoscópica para adenocarcinoma da flexura esplênica (abordagem de medial a lateral)


腹腔镜左半结肠切除术治疗脾曲癌（从内侧到外侧）


Hémicolectomie gauche laparoscopique pour adénocarcinome de l’angle gauche (approche médiale à latérale)


Лапароскопическая левосторонняя гемиколэктомия по поводу рака селезеночного изгиба ободочной кишки: медиа-латеральный доступ


Hemicolectomía izquierda laparoscópica para adenocarcinoma de la flexura esplénica (abordaje de medial a lateral)


Complete mesocolic excision (CME) with central vessel ligation (CVL) was first introduced with the aim to preserve an intact layer of mesocolon, containing all blood vessels, lymphatic vessels, lymph nodes, and surrounding soft tissue during colorectal cancer resection. The supplying vessels are also transected at their origin for optimal oncological outcomes. This method has been extensively studied in right colonic cancers with improvement in local recurrence and survival rates when compared to the conventional approach. Its excellent results are attributed to the superior lymph node harvest and removal of disseminated cancer cells in the surrounding soft tissue. Similarly, such advantages can be translated to left hemicolectomy with the use of CME with a CVL approach. Additionally, in left hemicolectomy, the vessels ligated (left branch of middle colic and left colic) are branches of vessels from the aorta rather than from the aorta directly, often limiting lymph node harvest. CME with CVL can help to overcome this limitation in left hemicolectomy. We present a video of a laparoscopic CME and CVL in a 48-year-old Chinese male with large bowel obstruction secondary to a descending colonic tumor which was successfully stented one week before.

Laparoscopic left complete mesocolic excision for stented descending colon cancer

Escisión completa del mesocolon izquierdo laparoscópica para cáncer del colon descendente con stent


Excisão completa do mesocólon esquerdo laparoscópica para câncer do cólon descendente com stent


Excision mésocolique gauche complète par voie d'abord laparoscopique pour cancer du côlon descendant avec endoprothèse


Лапароскопическая левосторонняя полная мезоколонэктомия по поводу стентированной аденокарциномы нисходящей ободочной кишки


腹腔镜左支全结肠切除术用于支架降结肠癌


In this educational video, Professor Luc Soler gives a brief introduction of 3D reconstruction and modeling. Dr. Corcione introduces the main principles of trocar and port placement. He briefly demonstrates the technical aspects, main principles and key steps of laparoscopic sigmoidectomy for cancer in a 61-year-old male patient in a live interactive surgery. He highlights the technical aspects and main principles of lesser sac opening, vascular identification and division, splenic flexure mobilization, lateral mobilization, transection, suprapubic incision for specimen removal, and EEA anastomosis.

LIVE INTERACTIVE SURGERY: Interactive discussion around splenic flexure during laparoscopic sigmoidectomy for cancer

CHIRURGIE LIVE INTERACTIVE: discussion intéractive sur l'angle colique gauche 


CIRURGIA INTERATIVA AO VIVO: Discussão interativa sobre a flexura esplênica durante sigmoidectomia laparoscópica para câncer


LIVE хирургия: интерактивная дискуссия по поводу изгиба селезёнки при лапароскопической сигмоидэктомии по поводу рака

实时交互式手术：腹腔镜乙状结肠癌切除术期间脾曲挠的互动讨论


CIRUGÍA INTERACTIVA EN VIVO: Discusión interactiva acerca de la flexura esplénica durante sigmoidectomía laparoscópica para cáncer


video lecture

Technique selon Melani à trois trocarts pour mobilisation de l'angle colique gauche


Трёхпортовая техника Мелани по поводу мобилизации селезёночного изгиба ободочной кишки


In this key lecture, Dr. Huscher briefly describes the three-port Melani technique for splenic flexture mobilization. He demonstrates trocar position as well as the main principles of gastrocolic ligament division and technical aspects of splenic flexure taking down according to the Melani technique along with a video case presentation.

Three-port Melani technique for splenic flexure mobilization

Mobilisation de l'angle colique gauche

Мобилизация селезеночного изгиба ободочной кишки


Colorectal Splenic Flexure Mobilization