How to do it: Splenic flexure mobilisation via medial trans-mesocolic approach

Area of Science:

• Surgical Techniques
• Colorectal Surgery
• Anatomy

Background:

• Complete splenic flexure mobilization is a crucial step in left-sided colorectal resections.
• Surgeons utilize anterior, medial, and lateral approaches to divide peritoneal ligaments.
• Mobilization decisions impact surgery time and complication risk, though outcomes are minimally affected.

Purpose of the Study:

• To outline the medial trans-mesocolic approach for splenic flexure mobilization.
• To provide a video guide for performing this technique during left-sided colorectal resections.

Main Methods:

• Patient positioned in lithotomy.
• Exposure of the duodenal-jejunal flexure.
• Ligation of the inferior mesenteric vein.
• Medial to lateral dissection for mobilization.

Main Results:

• Successful splenic flexure mobilization using the medial trans-mesocolic approach.
• Demonstration of key steps including duodenal-jejunal flexure exposure and inferior mesenteric vein ligation.
• Low risk of pancreatic injury, though other structures may be at risk.

Conclusions:

• The medial trans-mesocolic approach is a viable technique for splenic flexure mobilization.
• This method facilitates left-sided colorectal resections.
• Video demonstration aids surgical training and understanding.