Laparoscopic left colonic resection – how to perform it in our institute?

Kazuki Ueda, MD, Koji Daito, MD, Fumiaki Sugiura, MD, Tadao Tokoro, MD, Haruhiko Imamoto, MD, Jin-ichi Hida, MD, Kiyotaka Okuno, MD

Department of Surgery, Kinki University Faculty of Medicine

Introduction: Laparoscopic left colonic resection will perform for (left sided) transverse colon cancer or descending colon cancer. There are few cases in total number of colorectal cancers. Our institute started laparoscopic colorectal surgery from 1995 and expanded the indication by the technical level of proficiency. Total 495 cases were undergone for colorectal malignancies up to August, 2012. In spite of 33% for ascending colon cancer (including cecal cancer) or 44% for sigmoid colon cancer (including recto-sigmoid colon cancer), there were only 5% for transverse/descending colon cancer. Therefore, the technical level of proficiency of laparoscopic left colonic resection is slow. We herein present how to perform laparoscopic left colonic resection in our institute.

Procedure: The patient is placed lithotomy position. The initial 12-mm camera trocar is placed at the umbilical area with Hasson technique. A flexible 5mm camera is introduced through the first trocar. After pneumoperitoneum is established up to 8 mmHg and working spaces are created, the remaining 4 (5mm) trocars are placed under direct vision. The medial-to-lateral approach is performed, and then the inferior mesenteric artery (IMA) is exposed and lymph node dissection is performed by preserving IMA. The left colic artery (LCA) is identified and divided on its origin. The inferior mesenteric vein (IMV) is divided at the same level of LCA. The left colic mesentery is widely mobilized above the left kidney or the inferior level of pancreas. After dissecting the greater omentum from transverse colon, bursa omentalis is opened. Transverse mesocolon is dissected from lower edge of the pancreas. Finally, the splenic flexure is fully mobilized with combined approach (laterally, anteriorly, and posteriorly). The specimen is extracted through a mini-laparotomy (4-5 cm) at the umbilicus. The functional end-to-end anastomosis is created with linear stapler device.

Conclusions: Laparoscopic left colonic resection is technically difficult, but it can be done with highly standardized procedures. A key step of this procedure is wide mobilization of left colonic mesentery and the exposure of the inferior border of pancreas.

Session: Poster Presentation

Program Number: P036

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