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Abstract
Oncologic laparoscopic colectomy represents a fully validated surgical approach to the management of colorectal cancer. However, laparoscopic surgery for distal transverse and descending colon lesions remains a challenging procedure. A total laparoscopic approach to the left colectomy is an interesting option for critically ill patients although reports in the literature on this subject are scarce and its approach still not standardized because of its selective nature for indication. There are several advantages associated with conduction of totally laparoscopic approach to the left colon. Intracorporeal vessel sealing ensures an adequate lymph node dissection. Moreover, it enables the construction of a well-vascularized anastomosis. Ultimately, the occurrence of late wound complications are possibly reduced for the placement of a low abdominal incision exclusively used for specimen extraction. This paper aimed at describing our technique for a totally laparoscopic left colectomy for distal transverse and descending colon lesions.
Highlights
Since the publication of the first laparoscopic colectomy its use has been increased.[1] randomized trials have demonstrated that laparoscopic surgery for colon cancer achieves good short-term and oncologic outcomes similar to those find in open surgery.[2,3] laparoscopic surgery for transverse and descending colon cancer requires an advanced technique
Regarding the extent of lymphadenectomy, there is evidence in favor of extended right colectomies over segmental left colectomies for the treatment of distal transverse and left colon cancers.[6]. In addition, the extensive lymphadenectomy associated with the extended right colectomy for these tumors abolishes the risk of metachronous cancer.[7] the ileocolic anastomosis is probably safer than the colo-colic anastomosis
Midline extraction sites have a higher chance of hernias than nonmidline.[9] a totally laparoscopic operation for distal may result in less incisional hernias since the specimen extraction may be done through a small suprapubic incision
Summary
Since the publication of the first laparoscopic colectomy its use has been increased.[1]. Dissection and sealing of the left branch of the MCA are performed close to the mesenteric border of the transverse colon using a Harmonic AceTM. The insertion of distal transverse mesocolon to the pancreas is completely divided from the level of the left branch of the MCA to the splenic flexure (Figures 1C, 1D, and 1E). After complete transection of the round and falciform ligaments to the diaphragm level, the distal transverse colon is folded cranially over the stomach (Figure 1B). This presentation enables an adequate medial to lateral approach to structures at the Treitz angle (IMV, ventral pancreatic border and MCA).
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