Laparoscopic Left Colectomy

Abstract

In laparoscopic left colectomy, the mobilisation of the sigmoid colon and the splenic flexure of the colon are necessary. Although the surgical approach in the splenic flexure of the colon is not easy because of the thickened omentum, it is ensured with an understanding of the fascial configuration. The area supplied by the inferior mesenteric artery is a lymph node dissection region, and dissection around the left colic artery is also important. The mobilisation of the splenic flexure of the colon is often performed using the lateral approach from the sigmoid-descending colon and the medial approach from the omentum. In considering the fascial structure of the splenic flexure of the colon, it is important to determine which fascia should be recognized as the anatomical landmark. In other words, the deep subperitoneal fascia, which is ventral to the spermatic vessels, and the ureter are suitable anatomical landmarks, while the fascia on the colon side should never be used as an anatomical landmark. In addition, the third sheet of the dorsal mesentery is an anatomical feature suitable for dissection of the fascia of the transverse colon, as is the fascia of the dorsal side of the omental bursa.