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Laparoscopic radical left hemicolectomy: a bursa omentalis approach

Wei Wang, Wenjun Xiong, Jin Wan, Xiaofeng Zhu. Guangdong Provincial Hospital of Chinese Medicine

In several classic trials comparing laparoscopic versus open colectomy, splenic flexure cancer was excluded. One of the most important reasons was the technical difficulty of laparoscopic splenic flexure mobilization. Separating left Toldt’s fascia was prior to entering the bursa omentalis in conventional laparoscopic left hemicoletomy. However, in this approach, identifying pancreas is very demanding, especially for fatty patients, and it is easy to enter the retro-pancreatic space for unexperienced surgeons. Herein, we introduce a bursa omentalis approach for laparoscopic radical left hemicoletomy to facilitate splenic flexure mobilization and explore its safety and feasibility.

Firstly, the left part of gastrocolic ligament was dissected and the bursa omentalis was entered. It was easy to identify the middle colic vessel and inferior mesenteric vein. The anterior lobe of the mesentery of transverse colon was dissected at the inferior border of pancreas from right to left  and a piece of gauze was placed at the inferior border of pancreas for introduction.

Secondly, the left Toldt’s fascia was dissected at the level of the sacral promontory. The left Toldt’s space was expanded cephalad and the pancreas was identified clearly with the introduction of the gauze. Meanwhile, the inferior mesenteric artery and vein were ligated at root. It was easy to combine the left Toldt’s space and bursa omentalis.

Thirdly, the lateral attachments of the descending colon were completely mobilized and an extracorporeal side-to-side anastomosis was performed with an umbilical incision.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93452

Program Number: V293

Presentation Session: Video Loop Day 3

Presentation Type: VideoLoop

81

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