Additionally, an intracorporeal anastomosis minimizes the risk of bowel twisting, preventing the exteriorization of the stumps, and reducing bowel traction, which can affect anastomotic irrigation, especially in obese patients.
The experience with a totally laparoscopic approach with intracorporeal anastomosis is well described in the current literature. As a result, a segmental resection associated with a medial-to-lateral approach could be safe and effective. Different studies showed that the majority of positive lymph nodes among patients with splenic flexure carcinoma are distributed along the paracolic arcade and the left colic artery. The oncological effectiveness of a segmental resection could be determined by the peculiar lymphatic spread of splenic flexure cancers. The resected area must include the mesocolon with major vessels ligation at their origin, in order to reduce local recurrence via the complete removal of potentially involved lymph node stations. The surgical approach is challenging and not fully standardized. It is associated with a high risk of obstruction and a poor prognosis. Splenic flexure carcinoma is a rare condition, as it represents 3 to 8% of all colon cancers. The objective of this video is to demonstrate a laparoscopic segmental oncological splenic flexure colonic resection for cancer. A laparoscopic intracorporeal anastomosis is mandatory and can be performed using a hand-sewn method. The patient was discharged after 4 days, and at visit consultations, the symptoms were resolved.Ĭonclusion: Single incision laparoscopic splenic flexure resection can be safely performed using a suprapubic access, which enhances cosmetic outcomes, in addition to the advantages of minimally invasive surgery. Results: Laparoscopic time was 165 minutes and time to perform the anastomosis was 60 minutes. The specimen was removed through a single access and final scar appeared to be 4cm. An intracorporeal end-to-end transverse sigmoid anastomosis was performed using two converging running sutures. After having completely freed the splenic flexure from its attachments, the transverse colon and the left colon were divided using an articulating linear stapler, introduced into the abdomen under a 5mm, 30-degree long scope. The mobilization of the left mesocolon as well as of the transverse mesocolon was performed. DAPRI curved reusable instruments (Karl Storz Endoskope, Tuttlingen, Germany) were used, in addition to a 10mm, 30-degree regular length scope. Video: A right suprapubic incision was performed and allowed for the introduction of three abdominal trocars (11mm, and two 6mm ones). The patient was scheduled for a suprapubic single incision laparoscopic splenic flexure resection. Shen-Ann Eugene Yeo, MBBS, MMed (Surg), FRCS (Ed) does not have any conflicts of interest or financial ties to disclose.īackground: The authors report the case of a 30-year-old woman who consulted for episodes of diverticulitis due to segmental diverticulosis of the splenic flexure. This video attempts to provide a systematic approach to performing a laparoscopic splenic flexure mobilization as part of a colorectal resection.Ī detailed stepwise approach to splenic flexure mobilization will be shown here, as part of an anterior resection with splenic flexure takedown for a proximal sigmoid cancer.ĭr. As such, splenic flexure mobilization remains a challenge for many laparoscopic surgeons, particularly those who are at the early stages of their careers. Additionally, in obese patients, the large amount of mesenteric and omental fat can make it even more challenging to dissect. Also, critical organs which are prone to injury, namely the spleen and the pancreas, and the many blood vessels around them, lie very close to this area of dissection. Frequently, omental and congenital adhesions get in the way of a clear dissection plane. This is because of various factors, namely that the splenic flexure tends to be high up in the abdomen which may lead to difficulty of instrument reach. as part of a left hemicolectomy or anterior resection) tends to be one of the most challenging aspects. Among the different laparoscopic colorectal surgical procedures which are commonly performed, splenic flexure mobilization (e.g.
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