Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study

How Much Colonic Redundancy Could Be Obtained by Splenic Flexure Mobilization in Laparoscopic Anterior or Low Anterior Resection?

“…A study with 20 cadaveric models demonstrated that a mean 28.3-cm mobilized colonic segment was achieved after full mobilization of the distal transverse colon. These authors regarded full mobilization as detachment of the distal transverse and descending colons by using the same method as ours and high ligation of the IMV 7. Another study with 13 adult fresh cadavers demonstrated that the length of colon gained after high ligation of IMA and IMV and SFM (28.75 ± 5.72 cm) altogether was greater than that after any of the other procedures (low IMA ligation with high ligation of IMV and SFM, or low IMV ligation with SFM and high IMV ligation, and etc.)…”

“…There were 2 recent cadaveric studies for the elongation of colon by SFM 7, 8. A study with 20 cadaveric models demonstrated that a mean 28.3-cm mobilized colonic segment was achieved after full mobilization of the distal transverse colon.…”

“…Two cadaveric studies recently demonstrated the degree to which the use of SFM could lengthen the colon 7,8. However, no study has measured colon elongation by SFM during actual surgery, especially in laparoscopic surgery.…”

The role of splenic flexure mobilization in laparoscopic rectal surgery for rectal cancer

“…In a cadaveric study done by Thum-umnuaysuk et al [7] , a greater length of colon at 17.98 ± 6.80 cm was achieved and it reached statistical significance when high ligation of IMA and IMV coupled with SFM was done. In a separate cadaveric study by Araujo et al [11] , it was shown that an additional 10 to 28 cm segment of the descending colon can be gained if SFM was carried out with or without distal transverse colon mobilization. Kye et al [15] cited that as much as 30 centimeters of colon redundancy will be reached if high IMV ligation was performed as compared to a low IMV ligation which gains 5 centimeters less.…”

“…SFM is one of the essential, challenging and technically demanding step during laparoscopic rectal cancer surgery. The use of SFM for CRC surgery remains a contentious issue [5,6,8] , but safe dissection of the splenic flexure to fully mobilize the descending colon is mandatory not only for oncologic resection but also for safe anastomosis [4,[9][10][11] . The definition of SFM is different among several studies with some describing the technique as either complete or partial mobilization [3,5,6,12] .…”