Methods for Control of the Inferior Mesenteric Artery in Laparoscopic Left Colon Resections

Abstract

In the world of modern medicine, the laparoscopic methods for treating benign and malignant diseases of the colon are gaining worldwide popularity and acceptance. With their 25-year history of development and improving advantages they are slowly becoming the preferred option from the physicians approach towards this pathology. The minimally invasive surgery of the colon is still facing various challenges such as the adequate presentation of the anatomic planes and landmarks, the reduced possibility of tissue manipulation and peculiarities of hemostasis control.One of the key steps in laparoscopic left colon resections is the localizing and exposing of the inferior mesenteric artery (IMA) and vein (IMV), and their ligation after. This provokes various questions concerning the place and the preferred method of their division. In case of malignancy, after mobilizing the sigmoid colon and identifying the left urether, the artery is divided proximally above its bifurcation around 2-2.5 cm after emerging from the abdominal aorta. The vein is ligated below the lower margin of the pancreas. This allows the adequate dissection of the mesocolic lymph collectors. High ligation of the inferior mesenteric vessels is more and more widely applied during laparoscopic resections for benign pathology.The technical procedure of dividing the IMA during laparoscopic resection is more complicated than in the conventional open operation which is due to the specifics of the method. IMA can be ligated in one of several ways: dividing with a linear stapling device with closed staple with the height of 1.0 mm; ligating with titanium clips; using a polymer locking ligating system (Weck® Hem-o-lok®); ligating using bipolar diathermo coagulation (Medtronic-LigaSureâ„¢) or ultrasound (Ethicon - HARMONIC ACE®); classic silk ligatures.The methods of hemostatic control are in constant development and improvement, and especially fascinating is the evolution of energy sealing devices.