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. 2019 Jul-Sep;15(3):268-272.
doi: 10.4103/jmas.JMAS_118_18.

A standardised and simplified technique for laparoscopic resection of the splenic flexure

Marco Lotti  1 , Elia Poiasina  2 , Gabor Panyor  2 , Michele Marini  2 , Michela Giulii Capponi  2 , Nadiane Paderno  2 , Pietro Calcagno  2 , Eugenio Poletti  2 , Luca Campanati  2
Affiliations

A standardised and simplified technique for laparoscopic resection of the splenic flexure

Marco Lotti et al. J Minim Access Surg. 2019 Jul-Sep.

Abstract

The splenic flexure is an uncommon location of colorectal cancer, being involved in 2%-3% of cases. The low chance of being engaged in resecting cancer of the splenic flexure can make it difficult for surgeons to build their learning curve and to achieve a reliable experience. As the majority of colectomies are still performed by low-volume surgeons, there is growing agreement that providing local services with adequate surgical education and training could be an effective strategy to improve outcomes and global health. Arming surgeons with simplified and easy-to-learn surgical techniques could be an important step of this strategy. A novel simplified technique for laparoscopic resection of the splenic flexure is presented, which combines laparoscopic mobilisation of the right colon with extracorporeal vascular ligation and bowel anastomosis.

Keywords: Colon cancer; colon resection; colorectal cancer; laparoscopic colectomy; splenic flexure.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Positioning of the patient
Figure 2
Figure 2
(a) Port-site placement, (b and c) trocar triangulation
Figure 3
Figure 3
Anatomy key points
Figure 4
Figure 4
(a and b) Creation of the peritoneal window, (c) preparation of the IMA, (d) preparation of the LCA
Figure 5
Figure 5
(a) Incision of the left paracolic gutter, (b) conjunction with the peritoneal window, (c) detachment of the sigmoid colon at the pelvic inlet, (d) end of mobilisation of the descending colon
Figure 6
Figure 6
(a and b) Division of the gastrocolic, (c) splenocolic and (d) phrenicocolic ligaments
Figure 7
Figure 7
(a and b) Dissection of the root of the transverse mesocolon at the lower edge of the pancreas, (c and d) exposure of the head of the pancreas
Figure 8
Figure 8
(a) Abdominal incision between the U-T and the EPI-T, (b) exteriorisation and (c) division of the colon, (d) division of the left branch of the MCA
See this image and copyright information in PMC

References

    1. Hayne D, Brown RS, McCormack M, Quinn MJ, Payne HA, Babb P, et al. Current trends in colorectal cancer: Site, incidence, mortality and survival in England and Wales. Clin Oncol (R Coll Radiol) 2001;13:448–52. - PubMed
    1. Carlini M, Spoletini D, Castaldi F, Giovannini C, Passaro U. Laparoscopic resection of splenic flexure tumors. Updates Surg. 2016;68:77–83. - PubMed
    1. Okuda J, Yamamoto M, Tanaka K, Masubuchi S, Uchiyama K. Laparoscopic resection of transverse colon cancer at splenic flexure: Technical aspects and results. Updates Surg. 2016;68:71–5. - PubMed
    1. Pisani Ceretti A, Maroni N, Sacchi M, Bona S, Angiolini MR, Bianchi P, et al. Laparoscopic colonic resection for splenic flexure cancer: Our experience. BMC Gastroenterol. 2015;15:76. - PMC - PubMed
    1. Fiscon V, Portale G, Migliorini G, Frigo F. Splenic flexure colon cancers: Minimally invasive treatment. Updates Surg. 2015;67:55–9. - PubMed

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