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

Wei, Meng; Wang, Ziqiang; Zhou, Zong‐Guang

doi:10.1111/codi.12297

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…1,2 It also has a profound effect on postoperative length of stay, and short and longterm survival. 3 It is therefore useful to know that there are anatomical differences between men and women that may influence the ease of performing SFM. Future research should use this information to produce a predictive score of how difficult it would be to perform SFM.…”

Section: Is Ct a Suitable Technique To Analyse This Anatomy?mentioning

confidence: 99%

“…Splenic flexure mobilisation (SFM) is associated with significant potential complications, which include haemorrhage necessitating splenectomy, longer operating time, 1,2 and decreased 30-day and 5-year survival. 3 The aim of this study was to assess quantitatively whether there is an anatomical difference in the position of the splenic flexure between men and women using computed tomography (CT).…”

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confidence: 99%

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Sex differences in the splenic flexure

Brookes

Macano

Stone

et al. 2017

annals

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INTRODUCTION Anecdotally, surgeons claim splenic flexure mobilisation is more difficult in male patients. There have been no scientific studies to confirm or disprove this hypothesis. The implications in colorectal surgery could be profound. The aim of this study was to assess quantitatively whether there is an anatomical difference in the position of the splenic flexure between men and women using computed tomography (CT). METHODS Portal venous phase CT performed for preoperative assessment of colorectal malignancy was analysed using the hospital picture archiving and communication system. The splenic flexure was compared between men and women using two variables: anatomical height corresponding to the adjacent vertebral level (converted to ordinal values between 1 and 17) and distance from the midline. RESULTS In total, 100 CT images were analysed. Sex distribution was even. The mean ages of the male and female patients were 68.1 years and 66.7 years respectively (p=0.630). The mean vertebral level for men was 8.88, equating to the inferior half of the T11 vertebral body (range: 1-17 [superior half of T9 to inferior half of L2]), and 11.36 for women, equating to the inferior half of the T12 vertebral body (range: 4-16 [superior half of T10 to superior half of L2]). This difference was statistically significant (p=0.0001) and is equivalent to one whole vertebra. The mean distance from the midline was 160.8mm (range: 124-203mm) for men and 138.2mm (range: 107-185mm) for women (p<0.0001). CONCLUSIONS The splenic flexure is both higher and further from the midline in men than in women. This provides one theory as to why mobilising the splenic flexure may be more difficult in male patients.

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Section: Is Ct a Suitable Technique To Analyse This Anatomy?mentioning

confidence: 99%

mentioning

confidence: 99%

Sex differences in the splenic flexure

Brookes

Macano

Stone

et al. 2017

annals

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“…3 SFM is also associated with longer operative time regardless of surgery type. 5,6 We hypothesised that the difficulty of SFM is related to the anatomical height of the splenic flexure (ie difficulty increases with distance from the midline). Studies using computed tomography (CT) for anatomical assessment of the splenic flexure are lacking.…”

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confidence: 99%

Anatomical siting of the splenic flexure using computed tomography

Meecham

Brookes

Macano

et al. 2017

annals

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Anatomical siting of the splenic flexure using computed tomography L Meecham, A Brookes, CAW Macano, T Stone, M Cheetham Shrewsbury and Telford NHS Trust, UK ABSTRACT INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (k) value of 0.742 (95% confidence interval (CI), 0.463-0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: k = 0.905 (95% CI, 0.785-0.961); CVBI: 0.951 (0.890-0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.

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