Complete Versus Partial Mobilization of Splenic Flexure During Laparoscopic Low Anterior Resection for Rectal Tumors: A Comparative Study

Gezen, Cem; Altuntas, Yunus Emre; Kement, Metin; Vural, Selahattin; Civil, Osman; Okkabaz, Nuri; Aksakal, Nihat; Öncel, Mustafa

doi:10.1089/lap.2011.0409

Cited by 22 publications

(21 citation statements)

References 16 publications

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“…The complete option consisting of the division of the splenocolic, phrenicocolic, gastro colic and pancreaticomesocolic ligaments. In partial SFM, it is limited only to the division of splenocolic and phrenicocolic ligaments while the gastro-colic and pancreaticomesocolic attachments are not divided (9). Gezen C et al demonstrated in their study the advantages of a complete SFM especially in patients who are candidates for a reservoir formation (9).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Mobilization of the Splenic Flexure as the First Step of Restorative Colorectal Resection

Copăescu¹,

Barbulescu²,

Tomulescu³

2019

chr

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RezumatIntroducere: Mobilizarea unghiului splenic al colonului este o etapă chirurgicală esenţială în cadrul rezecţiilor colo-rectale restaurative. Pe de altă parte, această procedură chirurgicală este complexă din punct de vedere tehnic şi necesită o lungă curbă de învăţare. Cu scopul îmbunătăţirii rezultatelor postoperatorii, în 2016 am decis să efectuăm în mod uzual mobilizarea unghiului splenic ca o primă etapă a tuturor rezecţiilor sigmoidiene şi rectale laparoscopice/robotice. Scopul acestei lucrări este acela de a descrie tehnica mobilizării laparoscopice a unghiului splenic şi de a discuta avantajele utilizării acestei metode ca prim pas în rezecţia colo-rectală, analizând experienţa ultimelor 12 luni (2018). Metodă: Tehnica laparoscopică de mobilizare a unghiului splenic colonic este descrisă detaliat. Există patru căi de efectuare a acestei tehnici chiurgicale: două dintre ele dinspre median spre lateral, unul pornind de la vena splenică, celălalt de la promontoriu, un abord superior, cranio-caudal şi unul dinspre lateral. Combinarea strategică a diferitelor căi de abord în vederea disecţiei unghiului splenic poate reprezenta o soluţie fezabilă şi sigură, reducând morbiditatea şi timpul chirurgical. Rezultate: In cadrul Poderas Academic Hospital, în perioada ianuarie-decembrie 2018, mobilizarea unghiului splenic ca prim pas al rezecţiei colo-rectale s-a practicat la 47 de pacienţi. Dintre aceştia, 30 de pacienţi au fost operaţi pentru tumori rectale, 10 pentru tumori sigmoidiene, 5 pentru patologie benigna-diverticulităiar la 2 pacienţi s-a practicat repunere în tranzit după rezecţie recto-

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Mobilization of the Splenic Flexure as the First Step of Restorative Colorectal Resection

Copăescu¹,

Barbulescu²,

Tomulescu³

2019

chr

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“…Also, SFM during laparoscopic AR or LAR may be associated with longer operation time, patient repositioning, additional port insertion, or splenic injury 17,18. A mail-in survey of 35 experienced laparoscopic colorectal surgeons showed that SFM is one of the hardest procedures to perform6.…”

Section: Discussionmentioning

confidence: 99%

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

Kye¹,

Kim²,

Kim³

et al. 2014

Int. J. Med. Sci.

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Background and Objectives: Splenic flexure mobilization (SFM) is performed to ensure a tension free anastomosis with an adequate resection margin in laparoscopic anterior resection (AR) or low anterior resection (LAR). This retrospective study was performed to determine the amount of colonic redundancy that can be expected by SFM.Methods: Retrospective review of medical record for a total of 203 patients who underwent SFM during laparoscopic AR or LAR for the treatment of sigmoid colon or rectal cancer was performed.Results: The obtained redundancy of the colon by SFM was 27.81 ± 7.29 cm from the sacral promontory. The redundancy of the colon by SFM with high ligation of the inferior mesenteric vein (IMV) (29.54 ± 7.17 cm from the sacral promontory) was greater than that with low ligation of the IMV (24.94 ± 6.07 cm from the sacral promontory, P < 0.0001). It took about 9.82% of the total operation time to perform SFM. There was no intraoperative complication during SFM.Conclusions: SFM during laparoscopic AR or LAR is a safe and feasible option. Based on the result of this study, one can gain about 27.81 cm redundancy of the colon by SFM.

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“…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] . However, it is relevant to know the procedural aspect of SFM consisting of the division of the splenocolic, phrenicocolic, gastro colic and pancreaticomesocolic ligaments.…”

Section: Sfmmentioning

confidence: 99%

“…Laparoscopic surgery has gained increasing interest for the treatment of CRC. Laparoscopic approach for colon and rectal cancer was associated with less morbidity, enhanced recovery, and at least equivalent oncological outcomes [3][4][5][6] . In China Medical University Hospital (CMUH), a tertiary medical center in Taichung City, a team of colorectal surgeons performs a high volume of cases for laparoscopic rectal surgeries.…”

Section: Introductionmentioning

confidence: 99%

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

Geniales¹,

Chen²

2018

MIS

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How to cite this article: Ke TW, Geniales CR, Chen WTL. The role of splenic flexure mobilization in laparoscopic rectal surgery for rectal cancer. Mini-invasive Surg 2018;2:35. http://dx. AbstractLaparoscopic surgery for the treatment of colorectal cancer has gained an enormous advantage as compared to the traditional approach in terms of patient benefits. Although it has gained popularity among surgeons, there are still some contentious issues especially in laparoscopic rectal surgery. Splenic flexure mobilization is a crucial aspect of the procedure with complex technical details thereby establishing a learning curve that cannot be easily overcome. A team of colorectal surgeons at China Medical University Hospital adopted a standardized approach to laparoscopic rectal surgery particularly simplifying the steps involved in mobilizing the splenic flexure which is deemed as one of the difficult steps in the surgery.

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Complete Versus Partial Mobilization of Splenic Flexure During Laparoscopic Low Anterior Resection for Rectal Tumors: A Comparative Study

Cited by 22 publications

References 16 publications

Laparoscopic Mobilization of the Splenic Flexure as the First Step of Restorative Colorectal Resection

Laparoscopic Mobilization of the Splenic Flexure as the First Step of Restorative Colorectal Resection

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

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

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