Splenic flexure mobilization: our medial‐to‐lateral approach. Video Vignette

2021 ◽  
Author(s):  
Benedetto Neola ◽  
Serafino Vanella ◽  
Adele Noviello ◽  
Francesco Crafa
Keyword(s):  
Splenic Flexure ◽  
Lateral Approach ◽  
Splenic Flexure Mobilization ◽  
Video Vignette

scholarly journals Splenic flexure mobilization in low anterior resection

2019 ◽  
Vol 6 (4) ◽  
pp. 1040
Author(s):  
Ahmed Maher Megreya ◽  
Ahmed S. Elgammal ◽  
Mahmoud A. Shahin
Keyword(s):  
Rectal Cancer ◽  
Blood Loss ◽  
Anterior Resection ◽  
Splenic Flexure ◽  
Low Anterior Resection ◽  
Lateral Approach ◽  
P Value ◽  
Splenic Flexure Mobilization ◽  
Operative Blood Loss ◽  
Medial Approach

Background: The use of splenic flexure mobilization (SFM) for rectal cancer surgery is still controversial. SFM includes division of the splenocolic, phrenocolic, gastrocolic and pancreaticomesocolic ligaments, which is time-consuming. The aim of present prospective study of low anterior resection in case of cancer rectum was to compare splenic flexure mobilization (SFM) carried out by an extended medial approach with that by a lateral approach.Methods: A prospective study was carried out in General Surgery Department, Menoufia University, Egypt between October 2017 and December 2018. Patients were allocated randomly into two groups in which first group (group A) allocated to medial mobilization of splenic flexure and the second group was allocated into lateral approach of splenic flexure. The extended medial involved continuing the medial to lateral approach upwards to enter the lesser sac over the pancreas, thus permitting detachment of the splenic flexure. However, lateral approach involves dissection of retroperitoneal fascia.Results: Thirty patients, including 20 undergoing a lateral SFM and 10 an extended medial SFM, were evaluated. Mean number of lymph nodes in lateral and medial approach are (17.7±5.6, 24.3±6 respectively) with significant (P-value=0.04). Interestingly, Intra-operative blood loss in lateral approach is more than medial approach (175±25.3, 160.1±30 respectively) with significant (p-value=0.02). The interval to oral intake (3±0.3 days extended medial, 4.1±0.7 lateral, P=0.14).Conclusions: An extended medial approach for SFM during 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 higher number of harvested lymph nodes with less intra-operative blood loss.

Robotic vascular ligation, medial to lateral dissection and splenic flexure mobilization for rectal cancer - a video vignette

2018 ◽  
Vol 20 (2) ◽  
pp. 165-166 ◽  
Author(s):  
S.-G. Popeskou ◽  
S. Panteleimonitis ◽  
N. Figueiredo ◽  
T. Qureshi ◽  
A. Parvaiz
Keyword(s):  
Rectal Cancer ◽  
Splenic Flexure ◽  
Splenic Flexure Mobilization ◽  
Vascular Ligation ◽  
Video Vignette

Laparoscopic radical left hemicolectomy: Use of a bursa omentalis approach to ease splenic flexure mobilization.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15071-e15071
Author(s):  
Wei Wang ◽  
Wei Wang ◽  
Wenjun Xiong ◽  
Jin Wan
Keyword(s):  
Splenic Flexure ◽  
Operation Time ◽  
Lateral Approach ◽  
Splenic Flexure Mobilization ◽  
Left Hemicolectomy ◽  
Laparoscopic Operation ◽  
Bursa Omentalis ◽  
Significant Difference ◽  
Toldt’S Fascia ◽  
Radical Left

e15071 Background: Laparoscopic splenic flexure mobilization was technically difficult for left colon cancer. This study was aimed to compare the safety and feasibility of laparoscopic radical left hemicolectomy using a bursa omentalis approach (BOA) versus medial-to-lateral approach (MtLA). Methods: BOA was entering the bursa omentalis prior to separating left Toldt’s fascia. We retrospectively analyzed data of 32 cases undergoing laparoscopic radical left hemicolectomy using BOA, matching with using MtLA from January 2013 and October 2016. The matching factors consisted of gender, age, ASA score, BMI, and TNM stage. Data of intraoperative and postoperative characteristics were reviewed. Splenic flexure mobilization time was defined as laparoscopic operation time minus left Toldt’s fascia separating time. Results: There was no significant difference in average time of ambulation, time to first flatus, hospital stay between two groups. The operative time was also similar between two groups (134.2±27.6 min vs 139.4±23.5 min. P = 0.42), but there are significantly shorter splenic flexure mobilization time in BOA group (25.9±12.3 min vs 35.5±22.5 min. P = 0.03). No entry to posterior pancreatic space was recorded in BOA group and 9.4% (3/32) were wrongly entering to posterior pancreatic space when separating left Toldt’s fascia in MtLA group. However, there was no significant difference in intra- or postoperative complication between groups. Conclusions: Our initial results suggest BOA for laparoscopic radical left hemicoletomy may be safe and feasible approach especially for unexperienced surgeons. The main advantages of present approach contain easy to identify pancreas and avoiding wrongly entering posterior pancreatic space when expanding the left Told’s fascia.

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

2017 ◽  
Vol 19 (10) ◽  
pp. 948-949
Author(s):  
G. Dapri ◽  
N. A. Bascombe ◽  
G. B. Cadière ◽  
J. H. Marks
Keyword(s):  
Splenic Flexure ◽  
Splenic Flexure Mobilization ◽  
Video Vignette

Problem solving after marginal artery injury during splenic flexure mobilization - a video vignette

2015 ◽  
Vol 17 (2) ◽  
pp. 174-175 ◽  
Author(s):  
A. Mishra ◽  
M. P. Gosselink ◽  
N. J. Mortensen ◽  
B. D. George ◽  
C. Cunningham ◽  
...  
Keyword(s):  
Problem Solving ◽  
Splenic Flexure ◽  
Splenic Flexure Mobilization ◽  
Artery Injury ◽  
Marginal Artery ◽  
Video Vignette

Cranial-first approach for laparoscopic surgery with splenic flexure mobilization

2019 ◽  
Vol 23 (7) ◽  
pp. 693-694 ◽  
Author(s):  
A. Ogura ◽  
R. Kobayashi ◽  
T. Aritake ◽  
T. Maeda ◽  
K. Kawai ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Splenic Flexure ◽  
Splenic Flexure Mobilization

Splenic flexure mobilization in rectal cancer surgery: do we always need it?

2018 ◽  
Vol 71 (3) ◽  
pp. 505-513 ◽  
Author(s):  
Francesco Ferrara ◽  
Giuseppe Di Gioia ◽  
Daniele Gentile ◽  
Giulia Carrara ◽  
Davide Gobatti ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Splenic Flexure ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Splenic Flexure Mobilization

scholarly journals Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study

2012 ◽  
Vol 49 (3) ◽  
pp. 219-222 ◽  
Author(s):  
Sergio Eduardo Alonso Araujo ◽  
Victor Edmond Seid ◽  
Nam Jin Kim ◽  
Alexandre Bruno Bertoncini ◽  
Sergio Carlos Nahas ◽  
...  
Keyword(s):  
Splenic Flexure ◽  
Colorectal Anastomosis ◽  
Rectal Surgery ◽  
Sao Paulo ◽  
Left Colon ◽  
São Paulo ◽  
Splenic Flexure Mobilization ◽  
Sacral Promontory ◽  
Colon Segment ◽  
The Impact

CONTEXT: Failure of a colorectal anastomosis represents a life-threatening complication of colorectal surgery. Splenic flexure mobilization may contribute to reduce the occurrence of anastomotic complications due to technical flaws. There are no published reports measuring the impact of splenic flexure mobilization on the length of mobilized colon viable to construct a safe colorectal anastomosis. OBJECTIVE: The aim of the present study was to determine the effect of two techniques for splenic flexure mobilization on colon lengthening during open left-sided colon surgery using a cadaver model. DESIGN: Anatomical dissections for left colectomy and colorectal anastomosis at the sacral promontory level were conducted in 20 fresh cadavers by the same team of four surgeons. The effect of partial and full splenic flexure mobilization on the extent of mobilized left colon segment was determined. SETTING: University of Sao Paulo Medical School, Sao Paulo, SP, Brazil. Tertiary medical institution and university hospital. PARTICIPANTS: A team of four surgeons operated on 20 fresh cadavers. RESULTS: The length of resected left colon enabling a tension-free colorectal anastomosis at the level of sacral promontory achieved without mobilizing the splenic flexure was 46.3 (35-81) cm. After partial mobilization of the splenic flexure, an additionally mobilized colon segment measuring 10.7 (2-30) cm was obtained. After full mobilization of the distal transverse colon, a mean 28.3 (10-65) cm segment was achieved. CONCLUSION: Splenic flexure mobilization techniques are associated to effective left colon lengthening for colorectal anastomosis. This result may contribute to decision-making during rectal surgery and low colorectal and coloanal anastomosis.

Sign in / Sign up

Export Citation Format

Share Document