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Laparoscopic Left Colectomy

  • Makio Mike
Chapter

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.

Keywords

Laparoscopic left colectomy Fascial composition Fusion fascia Subperitoneal fascia 

References

  1. 1.
    Nakagoe T, Sawai T, Tsuji T, Jibiki M, Ohbatake M, Nanashima A, et al. Surgical treatment and subsequent outcome of patients with carcinoma of the splenic flexure. Surg Today. 2001;31:204–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Rouffet F, Hay JM, Vacher B, Fingerhut A, Ellhadad A, Flamant Y, et al. Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research. Dis Colon Rectum. 1994;37:651–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Levien DH, Gibbons S, Begos D, Byrne DW. Survival after resection of carcinoma of the splenic flexure. Dis Colon Rectum. 1991;34:401–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Steffen C, Boley EL, Chapuis PH. Carcinoma of the splenic flexure. Dis Colon Rectum. 1987;30:872–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Mike M, Kano N. Laparoscopic-assisted low anterior resection of the rectum – a review of the fascial composition in the pelvic space. Int J Colorectal Dis. 2011;26:405–14.CrossRefPubMedGoogle Scholar
  6. 6.
    Tobin CE, Benjamin JA, Wells JC. Continuity of the fascia lining the abdomen, pelvis, and spermatic cord. Surg Gynecol Obstet. 1946;83:575–96.PubMedGoogle Scholar
  7. 7.
    Sato T. Fundamental plan of the fascial strata of the body wall. Igakunoayumi. 1980;114:C168–75 (in Japanese).Google Scholar
  8. 8.
    Takahashi T. Vessels (1) – Basic structure of the artery and the intestinal rotation. Shoukakigeka. 1993;16:1580–97 (in Japanese).Google Scholar
  9. 9.
    Mike M, Kimura K, Kiyosawa Y. Anterior sheet dissection of the transverse colon” in the gastric cancer surgery. Shujyutu. 1999;53:103–8 (in Japanese).Google Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  • Makio Mike
    • 1
  1. 1.Department of Gastrointestinal SurgeryKameda Medical CenterKamogawaJapan

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