A video guide of five access methods to the splenic flexure: the concept of the splenic flexure box

Supra‐omental versus infra‐omental approach to antegrade transverse colon release during splenic flexure mobilization – a video vignette

“…Although different surgical approaches to achieve a complete SFM are described [4], the most challenging step to perform a complete SFM is the release of the transverse mesocolon.…”

Left upper abdomen: surgical anatomy

“…In particular, the left upper abdomen has two locations that need further surgical considerations: the lesser sac and the spleen. 3 The lesser sac is a natural space, a 'box', limited dorsally by the body and tail of the pancreas, and caudally by the transversa mesocolon, where the middle colic artery runs. Ventrally, the greater omentum will cover this box, together with the posterior side of the stomach.…”

Applied surgical anatomy is back (has it ever left?)

“…The splenic flexure surgical area is formed from the rotations of the primitive colon and primitive stomach that generate a virtual cavity, the lesser sac. The strategy to fully mobilize the colonic splenic flexure could be classified according to the way that the pneumoperitoneum enters in the lesser sac, distinguishing five different mobilization approaches depending on the embryological route that is used [4].…”

“…At the level of the head of the pancreas, it is named Fredet fascia and it is used as a landmark for a correct D3 right colectomy [7]. In the left side, at the level of the body and tail of the pancreas, it is named pancreatic-colic ligament and it is considered as a landmark for the medial mobilization of the splenic flexure [4].…”