How Much Colonic Redundancy Could Be Obtained by Splenic Flexure Mobilization in Laparoscopic Anterior or Low Anterior Resection?

Abstract

Background and Objectives: Splenic flexure mobilization (SFM) is performed to ensure a tension free anastomosis with an adequate resection margin in laparoscopic anterior resection (AR) or low anterior resection (LAR). This retrospective study was performed to determine the amount of colonic redundancy that can be expected by SFM.Methods: Retrospective review of medical record for a total of 203 patients who underwent SFM during laparoscopic AR or LAR for the treatment of sigmoid colon or rectal cancer was performed.Results: The obtained redundancy of the colon by SFM was 27.81 ± 7.29 cm from the sacral promontory. The redundancy of the colon by SFM with high ligation of the inferior mesenteric vein (IMV) (29.54 ± 7.17 cm from the sacral promontory) was greater than that with low ligation of the IMV (24.94 ± 6.07 cm from the sacral promontory, P < 0.0001). It took about 9.82% of the total operation time to perform SFM. There was no intraoperative complication during SFM.Conclusions: SFM during laparoscopic AR or LAR is a safe and feasible option. Based on the result of this study, one can gain about 27.81 cm redundancy of the colon by SFM.

Robotic left colectomy with complete mesocolectomy for splenic flexure and descending colon cancer, compared with a laparoscopic procedure

“…However, among laparoscopic colorectal procedures, splenic flexure resection and transverse colectomy were considered to be the most difficult in a survey of experienced laparoscopic colorectal surgeons . Several laparoscopic techniques have been used for splenic flexure cancer (SFC), while few data are available for robotic approaches aside from a single technical report …”

“…11 However, among laparoscopic colorectal procedures, splenic flexure resection and transverse colectomy were considered to be the most difficult in a survey of experienced laparoscopic colorectal surgeons. 12 Several laparoscopic techniques have been used for splenic flexure cancer (SFC), [13][14][15][16][17] while few data are available for robotic approaches aside from a single technical report. 18 Robotic approaches are increasingly used in colorectal surgery owing to their greater visualization of the surgical site and a high degree of dexterity.…”

Selective approach for splenic flexure mobilization in total mesorectal excision followed by low colorectal anastomoses

“…Современным стандартом хирургии рака средне ампулярного и нижнеампулярного отделов прямой кишки является ТМЭ [11], подразумевающая выделение кишки в межфасциальном аваскулярном пространстве, с сохранением собственной (мезоректальной) фасции прямой кишки. Во время выполнения ТМЭ обеспечивается радикальное удаление опухоли вместе с окружающей мезоректальной клетчаткой единым блоком как выше, так и ниже опухоли [12,13]. В дополнение к ТМЭ, которую можно условно назвать лимфодиссекцией 1-го уровня или, по японской классификации, D1 лимфодиссекцией, в нашей клинике стандартным является выполнение расширенной (в объеме D3) пара аортальной лимфодиссекции.…”

The three approaches to the colonic splenic flexure mobilization – a video vignette

“…The mobilization of the colonic splenic flexure during laparoscopic colorectal surgery can be a challenge, especially in anatomically difficult patients, but allows more than 20 cm of colonic redundancy . In this video the inframesocolic, the supramesocolic and the lateral‐to‐medial approaches are demonstrated.…”