An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection

Abstract

An extended medial to lateral approach for SFM during laparoscopic low anterior resection of rectal cancer appears to be an improvement over the previously used lateral approach, because it may provide a shorter operation time and shorter hospital stay.

Nomogram Prediction of Anastomotic Leakage and Determination of an Effective Surgical Strategy for Reducing Anastomotic Leakage after Laparoscopic Rectal Cancer Surgery

“…We speculate that the former might be attributed to the surgeon's learning curve and the latter might be attributed to the protective effect of extended SFM for AL. Previous studies have assessed whether fibrin glue application [14, 26], extended SFM [23], or a transanal drainage tube [24] can reduce the incidence of AL. However, none of these studies demonstrated a significant association between the strategy and AL.…”

“…After ligation of the inferior mesenteric vein at the lower border of the pancreas, dissection was continued over the anterior surface of the pancreas to the splenic hilum until the lesser sac entered. Then, the splenic flexure was easily mobilized, the lateral ligament was divided, and the omentum was subsequently dissected from the colon [23]. …”

“…Therefore, a diverting stoma should be avoided as much as possible. Several other strategies, such as the application of fibrin glue [14], the use of reinforcing sutures [22], splenic flexure takedown [23], and the use of a transanal drain tube [24], have been adapted to decrease the incidence of AL.…”

The Incidence and Risk of Early Postoperative Small Bowel Obstruction After Laparoscopic Resection for Colorectal Cancer

“…Since 2011, we have preferred an extended medial-to-lateral approach. 17 For clinical T4 CRC with suspected invasion into adjacent structures, when possible, laparoscopic inspection was attempted, and en bloc resection was performed. If laparoscopic resection was impossible because of invasion, the procedure was converted to open surgery.…”

Laparoscopic splenic flexure mobilization during low anterior resection for rectal cancer: a high‐level component of surgeon's armamentarium

“…Recently, Kim et al . reported SFM using an extended medial to lateral approach during laparoscopic low anterior resection for rectal cancer. The authors advocated that SFM should be routine during low anterior resection because it only extended the operation time by 15–20 min.…”