Difficult Splenic Flexure

George j Nassif, DO, John H Marks, MD, Joseph Frenkel, MD. Lankenau



This is the abstract for the video. A three trocar technique to release the splenic flexure followed by the application of technique for difficult splenic flexure in SILS left colectomy. This technique is first demonstrated with a video clip using a standard three trocar laparoscopic approach entering into the mesorectum by gaining entry into the lesser sac by incising the gastrocolic ligament in a patient with a BMI of 41. The essential points are position of the patient, opening of the gastrocolic ligament out to the splenic flexure followed by the releasing of the upper portion of the line of Toldt and going back medial to lateral liberating the transverse mesocolon from immediately inferior to the pancreas and mobilizing the mesentery of the splenic flexure off of the underlying Gerota’s fascia. Following this is shown the application of this approach for a very difficult splenic flecture using the SILS technique. The first patient shows application of this approach for acutely angulated splenic flexure where the greater omentum of the transverse colon is wrapped over the proximal descending colon making orientation and exposure challenging. Approaching this using the single port technique showing the good visualization and the way this needs to be approached in a back and forth fashion to allow safe liberation of the splenic flexure. The second patient shows a SILS approach for an extraordinarily high splenic flexure again demonstrating the same technique and the position of the hands and retraction necessary to obtain good visualization for a safe liberation of a high splenic flexure.

Session Number: VidTV1 – Video Channel Rotation Day 1
Program Number: V082

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