In this educational video, Dr. Armando Melani briefly demonstrates the main principles of laparoscopic sigmoidectomy for cancer in a 67-year-old female patient in a live interactive surgery. He highlights the technical aspects, anatomical landmarks, and key steps of lesser sac opening, vascular identification and division, splenic flexure mobilization, lateral mobilization, mesorectal transection, suprapubic incision for specimen removal, and end-to-end anastomosis (EEA).

Dr. P Sylla, MD (Massachusetts General Hospital, Boston, USA) provides a running comment on a laparoscopic sigmoidectomy for cancer performed by Dr. A Melani, MD, Scientific Director of IRCAD America Latina training centers in Barretos and Rio de Janeiro (Brazil). Dr. P Sylla provides an authoritative analysis of this colorectal procedure, with a large amount of tips and tricks.

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.

The video entitled "Transanal sigmoidectomy with TEO™ platform for adenocarcinoma", authored by J Leroy, A D'Urso, D Mutter, and J Marescaux is analyzed by Richard Whelan, MD (St. Luke's-Roosevelt Hospital Center, New York, NY, United States), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

The video entitled "Laparoscopic segmental sigmoidectomy for colon cancer: how I do it?", authored by J Leroy, A D'Urso, M Nedelcu, D Mutter, and J Marescaux is analyzed by Peter Marcello, MD (Lahey Clinic, Burlington, MA, United States), sharing his own personal experience and highlighting the different surgical approaches available with tips and tricks.

In this video, authors demonstrate a standardized technique to perform a segmental sigmoidectomy for cancer. The operative steps are clearly outlined and shown in this high-definition film. The standardization of the procedure is a major step in the reproducibility of the technique and in the quality of results. In oncology, it is essential to respect consensus guidelines which have been advocated by scientific societies. This video highlights the different protocols used and demonstrate them, bearing in mind that the best method is the standardization of the surgical procedure.

The objective of this film is to demonstrate the possibility of performing a purely transanal sigmoidectomy without laparoscopic assistance. The authors show that this approach, which has already been described for transanal rectal resection using the Perirectal Oncologic Gateway to Retroperitoneal Endoscopic Single-Site Surgery (PROGRESS) technique, is feasible and safe. Details as well as tips and tricks of this technique are clearly illustrated in a stepwise manner.

The video entitled "Laparoscopic oncologic sigmoidectomy for Tis (tumor in situ) with transanal specimen extraction", authored by J. Leroy and J. Marescaux is analyzed by Dr. Morris Franklin, MD, FACS, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

Introduction:
This is the case of a 65-year-old gentleman who presented with blood per rectum (PR) and symptoms of subacute obstruction. He was diagnosed with a stenotic invasive adenocarcinoma at 15cm from the anal verge and with liver metastases. After discussion at our multidisclipinary meeting, he was recommended to undergo palliative chemotherapy in the form of FOLFIRI and Avastin. Unfortunately, his symptoms of subacute obstruction worsened and it was recommended that he undergo a palliative resection.

Methods:
He underwent a palliative Laparoscopic Anterior Resection (LAR). Professor Armondo Melani utilized a 4-port technique with a 10mm umbilical optical port and 3 by 5mm working ports (2 on the right-hand side and one on the left). He used a medial to lateral approach starting with the splenic flexure takedown. This was achieved by entering the retroperitoneal plane cephalad to the inferior mesenteric artery (IMA) and inferior to the inferior mesenteric vein (IMV). Once the correct plane has been entered, the IMV was skeletonized and divided with a Ligasure® vessel-sealing device. The lesser sac was then entered superior and cephalad to the IMV, superior to the pancreas and to the left of the middle colic vessels. This novel approach allowed for easy identification of the pancreas and retroperitoneal mobilization of the mesocolon from the pancreas. The lesser sac was then entered above the transverse colon, the omental attachments divided and splenic flexure mobilization completed. The retroperitoneal plane was then entered caudally to the IMA, which was subsequently skeletonized and divided after identification of the left ureter and gonadal vessels. The rectum was then mobilized to >5cm below the tumor, the mesorectum divided, the rectum transected with an articulating linear stapling device. The specimen was delivered through a Pfannenstiel incision (with a wound protector). The specimen was transected and the anvil of a circular stapler inserted into the proximal colon with a purse-string suture. The colon was returned to the abdomen and the colorectal anastomosis was completed with the insertion of the circular stapler transanally.

This is the case of a patient presenting with a big polyp located 20cm away from the anal margin. It is a degenerated polyp, and a submucosal and lymphatic invasion can be noted. An oncologic resection of the sigmoid colon has been decided upon after the polyp was removed and localized by a clip.

Surgery in patients who have previously undergone abdominal operations is always difficult and the risk of complications is high. The objective of this film is to demonstrate a laparoscopic subtotal colectomy in an elderly female patient aged 89. This patient had undergone a laparoscopic right colectomy for cancer in previous years. The film also aims to show the possibilities of a laparoscopic re-intervention.

The aim of this video is to show the benefit of imaging when faced with anatomical abnormalities to avoid incidents during the surgical procedure. In this case, it is the left ureter that is abnormal, passing behind a section of the left iliac ureter, the latter being in fact an abnormally long left iliac artery and its course partially hiding the ureter. The procedure is a sigmoidectomy for cancer of the sigmoid colon in an averagely obese patient.

The purpose of this video is to demonstrate a technique for the identification of intracolonic polyps during laparoscopy. Numerous techniques have been described, in particular ultrasonic-assisted identification for lesions of the distal colon and upper rectum. We use this identification technique in a patient with a polyp situated 40cm from the anal margin.

The value and efficacy of laparoscopic colorectal surgery has been validated by large multicenter, randomized, controlled trials. This video shows a laparoscopic sigmoidectomy in a 74-year-old woman who underwent an incomplete endoscopic resection of a T1 adenocarcinoma tumor. Four trocars are used: two of 10mm and two of 5mm.

This video clearly demonstrates the technical details (exposure, vascular approach, colorectal dissection and anastomosis) to correctly perform a laparoscopic sigmoidectomy for cancer in a female patient.

We present a laparoscopic sigmoidectomy in an obese patient using the AirSeal device. This trocar uses a different approach: instead of establishing a seal around each instrument, this trocar offers a totally open passage from the outside to the intra-abdominal space – i.e. no diaphragm, valves, gels, etc. — and maintains the pneumoperitoneum using a pressure barrier.

This video clearly demonstrates the laparoscopic performance of left hemicolectomy for cancer.

This is a live video demonstration of a totally laparoscopic approach to right colectomy. The surgeon stands on the left side and performs a medial vascular approach including medial mobilization of the right colon and hepatic flexure. The specimen is resected and extracted before pneumoperitoneum is re-created for an intracorporeal ileo-colic stapled anastomosis. This technique is suitable for advanced laparoscopic surgeons.

This video highlights the critical steps in mobilization of the splenic flexure of the colon using the medial approach.

The author carries out the division of the left colic vessels and gains entry to the lesser sac. The tail of the pancreas, mesocolon, stomach, and posterior aspect of splenic flexure provide landmarks.

The author completes the dissection laterally and division of posterior attachment before commencing the freeing of the lateral structures. This provides access to the posterior dissection completed earlier.

This video demonstrates an uncomplicated laparoscopic sigmoid colectomy for cancer in a normal weight lady. The surgeon uses a medial approach to mesenteric mobilization and division of inferior mesenteric artery at the root. The hypogatric nerves, ureter and gonadal artery are identified. The splenic flexure is not mobilized due to the length of the bowel. The bowel is removed through a suprapubic incision and an EEA anastamosis is made.
This video is a good demonstration of key anatomical landmarks and surgical approach to sigmoid colectomy for cancer through the medial approach.

This video demonstrates the technique of medial approach to mesenteric mobilization and vascular dissection during a left hemicolectomy. The surgeon demonstrates the principles of trocar placement and internal retraction without the use of Trendelenburg.
This video is intended to provide basic review of medial mesenteric mobilization of the left colon.

The description of the laparoscopic sigmoidectomy for cancer covers all aspects of the surgical procedure used for the management of sigmoid colon cancer.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: exploration, exposure, vascular approach, mobilization of sigmoid colon, division of sigmoid colon, mobilization principles, lateral mobilization, medial mobilization, extraction of sigmoid colon, preparation of anastomosis, anastomosis.
Consequently, this operating technique is well standardized for the management of this condition.