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| Name | Colectomy, Prof.dr.mahmoud abd elnaby : |
| Video Uploader | Video From Mans ColoRectal Center |
| Upload Date | This Video Uploaded At 02-06-2019 11:51:24 |
| Video Discription | Laparoscopic non-anatomical total colectomy for pancolonic diverticulosis History: A case of a 38-year-old female patient presented to our clinic with left iliac fossa pain, and surgical history of appendectomy and three C-sections. The patient was diagnosed with an attack of acute diverticulitis (proved by post contrast CT scan of the abdomen and pelvis). The patient was managed conservatively until full resolution. Investigations: After resolution, the patient was referred for Virtual CT Colonoscopy, which revealed pancolonic diverticulosis. Also, routine laboratory investigations were done (within normal ranges). Then, the patient was scheduled for laparoscopic non-anatomical total colectomy with side to end ileorectal anastomosis. The technique (Video Clip): • [00:00 – 00:15] virtual CT colonoscopy • [not shown in the video] After bowel preparation, under general anesthesia, and after pneumoperitoneum, all ports were inserted. • [00:16 – 00:34] We started with adhesiolysis at the site of previous C-section to free the adherent omentum and uterus from the anterior abdominal wall to ease retraction of the omentum and gain access to the operative field. • [00:35 – 02:18] We proceeded to the right colon mobilization. This was achieved by division of adhesions and lateral peritoneal covering (at the paracolic gutter), then we proceeded to the medial side through a mesenteric window at the terminal ileum). After that, the terminal ileum was transected using endo-stapler (Ethicon, one blue staple, 60-mm). then, we continued devascularization of the ascending colon. • [02:40 – 05:20] After that, we proceeded to transverse colon mobilization. This was achieved by division of omental attachment, then devascularizaion (division of the mesocolon) with mobilization towards the hepatic flexure. During this, the middle colic artery was secured (using Liga clip) and divided. • [05:21 – 06:41] Then, we completed mobilization and devascularization towards the splenic flexure until the division of phrenico-colic ligament. • [06:42 – 08:29] We started mobilization of the left colon (through a mesenteric window at the rectosigmoid junction). First, we started by the division of the lateral peritoneal coverings (at the paracolic gutter). Then, we proceeded medially to divide the mesentry of the colon until complete mobilization of the left colon (the descending and sigmoid colons). • [not shown in the video] Then, the colon was divided at rectosigmoid junction using endo-stapler (Ethicon, two sequentially-applied green staples, 60-mm). The specimen was retrieved through a small Pfannesteil incision. • [08:30 – 09:33] The bowel continuity was restored through a side to end ileorectal anastomosis using a circular stapler (Covidien, 28). • [09:34 – 09:42] Finally, a nylaton drain was applied to the pelvis. • [09:43 – 09:52] Then, we can see the retrieved specimen and the slides of hitopathologic examination. Postoperative care & follow up: After weaning from anesthesia, the patient received the routine PO care. NPO was recommended. Oral intake started with clear fluids in the 2nd PO day, semi-solid food in the 4rd PO day, and was discharged in the 6th PO day. Histopathology: PO histopathologic examination revealed multiple diverticulae in the entire colon. Notes: Main surgeon Prof. Mahmoud Abd Elshafy PhD Assistant Surgeons Dr. Mohammed Balata MD Dr. Mohamed Arnouse MD Dr. Muhammad Fathi MD Anesthesiologist Prof. Sayed Emam PhD Pathologist Prof. Abdelhadi Shebl PhD Radiologist Prof. Sabry Elmogy PhD |
| Category | Education |
| Tags | Education Download MP4 | Education Download MP3 | Education Download MP4 360p | Education Download MP4 480p | Education Download MP4 720p | Education Download MP4 1080p |
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