Hellow guys, Welcome to my website, and you are watching LELC & modified partial Deloyers in 5 steps to achieve enough reach, preserving middle colic vessels. and this vIdeo is uploaded by Salomone Di Saverio MD, FACS, FRCS at 2021-07-18T09:11:18-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | LELC & modified partial Deloyers in 5 steps to achieve enough reach, preserving middle colic vessels |
| Video Uploader | Video From Salomone Di Saverio MD, FACS, FRCS |
| Upload Date | This Video Uploaded At 18-07-2021 16:11:18 |
| Video Discription | educational surgical technique How-I-Do-It associated with the following article https://doi.org/10.1007/s00423-021-02240-7 or as a PDF here https://link.springer.com/content/pdf/10.1007/s00423-021-02240-7.pdf Title Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels Journal Langenbeck's Archives of Surgery DOI 10.1007/s00423-021-02240-7 Publication Date 2021-07-16 Your article is available online here https://doi.org/10.1007/s00423-021-02240-7 or as a PDF here https://link.springer.com/content/pdf/10.1007/s00423-021-02240-7.pdf. How-I-Do-It articles Open Access Published: 16 July 2021 Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels Salomone Di Saverio, Kostantinos Stasinos, Weronyka Stupalkowska, Umberto Bracale, Pierpaolo Sileri, Antonio Giuliani, Giuseppe Nigri, Efstratios Kouroumpas, James M. D. Wheeler, Giovanni Domenico Tebala, Francesco Di Marzo, Belinda De Simone, Carlos Pastor Idoate, Nicola De Angelis, Roberto Cirocchi & Patricia Tejedor Langenbeck's Archives of Surgery (2021)Cite this article Abstract Introduction This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis. Background While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article. Technique and methods Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient. Results This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery. Conclusions Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function. |
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