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Colorectal Splenic Flexure Mobilization

Epublication, Jun 2017;17(06). URL: http://websurg.com/doi/ht01en27
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The 3 approaches to splenic flexure mobilization
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.
G Dapri, NA Bascombe, GB Cadière, J Marks
Surgical intervention
1 year ago
4129 views
340 likes
0 comments
11:51
The 3 approaches to splenic flexure mobilization
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.
Laparoscopic left complete mesocolic excision for stented descending colon cancer
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.
SAE Yeo, MH Chang
Surgical intervention
1 year ago
2880 views
315 likes
0 comments
08:47
Laparoscopic left complete mesocolic excision for stented descending colon cancer
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.
LIVE INTERACTIVE SURGERY: Interactive discussion around splenic flexure during laparoscopic sigmoidectomy for cancer
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.
F Corcione, D Mutter, J Marescaux
Surgical intervention
1 year ago
5988 views
320 likes
0 comments
58:02
LIVE INTERACTIVE SURGERY: Interactive discussion around splenic flexure during laparoscopic sigmoidectomy for cancer
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.