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Segmental left colectomy: a modified caudal-to-cranial approach.
Marco Milone1, Francesco Milone2
1Department of Surgical Specialities and Nephrology, University of Naples "Federico II", Via Pansini 5, 80131, Naples, Italy. milone.marco.md@gmail.com.
Surgical Endoscopy
|July 23, 2016
Summary
This study introduces a new laparoscopic left colectomy technique that preserves the inferior mesenteric artery. The modified approach demonstrated safety and efficacy in patients with benign colorectal diseases, with no conversions to open surgery.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Techniques
Background:
- Benign colorectal diseases necessitate surgical intervention, often involving colectomies.
- Laparoscopic colectomy offers advantages over open surgery but requires precise anatomical dissection.
- Preservation of major mesenteric vessels is crucial for maintaining bowel viability and function.
Purpose of the Study:
- To describe a modified caudal-to-cranial approach for laparoscopic left colectomy.
- To evaluate the safety and efficacy of this technique in preserving the inferior mesenteric artery.
- To assess the outcomes in patients undergoing this procedure for benign colorectal conditions.
Main Methods:
- A modified caudal-to-cranial dissection was developed for laparoscopic left colectomy.
- The inferior mesenteric artery was preserved throughout the procedure.
- Dissection involved separating the descending mesocolon and incising the peritoneal layer along the vessel.
- Sigmoid arteries were identified and sectioned close to the colonic wall.
- Anastomosis was performed transanally using a circular stapler.
Main Results:
- The technique was applied to 21 patients with benign sigmoid lesions (diverticulitis, polyps, endometriosis).
- Mean operative time was 161.4 ± 15.7 minutes, with a mean blood loss of 50 ± 40 ml.
- No conversions to open surgery were required.
- No instances of anastomotic leakage or stricture were observed.
- Minor complications included 2 cases of intraluminal bleeding and 1 wound infection.
Conclusions:
- The modified caudal-to-cranial approach is safe and effective for laparoscopic segmental colectomy.
- Preserving the inferior mesenteric artery is feasible with this technique.
- Sectioning the sigmoid artery close to the colonic wall simplifies the procedure and minimizes risks.
