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Laparoscopic splenic flexure mobilization during low anterior resection (LAR), extra central connection between the superior and inferior mesenteric arterial systems
This is the case of two adult patients who presented with a low rectal carcinoma. A low anterior resection was performed laparoscopically. In both cases, the procedure was begun with a mobilization of the splenic flexure to ensure sufficient length on the proximal colonic segment to facilitate a tension-free low colorectal anastomosis. In the first case, a small aberrant artery, and during the second case, an aberrant artery of greater caliber can be appreciated. Anatomical studies report an extra central arterial connection between the superior and inferior mesenteric arterial systems in addition to the marginal artery of Drummond in 10 to 30% of cases. In such cases, there is an extra connection from the ascending branch of the left colic artery to the middle colic artery or the marginal artery of Drummond. Different names have been given to these connections, such as for example the meandering mesenteric artery, the artery of Moskovitch and Riolan’s arch.
A Wijsmuller, RJ Franken, JB Tuynman, J Bonjer
Surgical intervention
9 months ago
6453 views
28 likes
0 comments
19:46
Laparoscopic splenic flexure mobilization during low anterior resection (LAR), extra central connection between the superior and inferior mesenteric arterial systems
This is the case of two adult patients who presented with a low rectal carcinoma. A low anterior resection was performed laparoscopically. In both cases, the procedure was begun with a mobilization of the splenic flexure to ensure sufficient length on the proximal colonic segment to facilitate a tension-free low colorectal anastomosis. In the first case, a small aberrant artery, and during the second case, an aberrant artery of greater caliber can be appreciated. Anatomical studies report an extra central arterial connection between the superior and inferior mesenteric arterial systems in addition to the marginal artery of Drummond in 10 to 30% of cases. In such cases, there is an extra connection from the ascending branch of the left colic artery to the middle colic artery or the marginal artery of Drummond. Different names have been given to these connections, such as for example the meandering mesenteric artery, the artery of Moskovitch and Riolan’s arch.
Tips 'n tricks: cholecystectomy: antegrade approach for difficult dissection
Today, laparoscopic cholecystectomy is a routinely performed surgical intervention. In certain cases, the identification of Calot’s triangle may be difficult due to adhesions or inflammatory infiltrations of adjacent structures. Hydrodissection can allow for an atraumatic dissection but in more complex cases, an antegrade freeing of the gallbladder should be envisaged.
Here we present the case of a man benefiting from a difficult laparoscopic cholecystectomy for a pancreatitis with common bile duct stone migration. The flag technique, with an antegrade freeing, must be applied in order to complete the procedure laparoscopically.
L Marx, C Hild, J Leroy, J Marescaux
Surgical intervention
5 years ago
4834 views
75 likes
0 comments
06:50
Tips 'n tricks: cholecystectomy: antegrade approach for difficult dissection
Today, laparoscopic cholecystectomy is a routinely performed surgical intervention. In certain cases, the identification of Calot’s triangle may be difficult due to adhesions or inflammatory infiltrations of adjacent structures. Hydrodissection can allow for an atraumatic dissection but in more complex cases, an antegrade freeing of the gallbladder should be envisaged.
Here we present the case of a man benefiting from a difficult laparoscopic cholecystectomy for a pancreatitis with common bile duct stone migration. The flag technique, with an antegrade freeing, must be applied in order to complete the procedure laparoscopically.
Three trocar laparoscopic sigmoidectomy for diffuse diverticulosis with transanal specimen extraction: tips and tricks
The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out.
Methods
The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed.
Conclusion
The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).
J Leroy, J Marescaux
Surgical intervention
7 years ago
2693 views
14 likes
0 comments
16:52
Three trocar laparoscopic sigmoidectomy for diffuse diverticulosis with transanal specimen extraction: tips and tricks
The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out.
Methods
The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed.
Conclusion
The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).