Cranial-first approach for laparoscopic surgery with splenic flexure mobilization

Ogura, Atsushi; Kobayashi, Ryosuke; Aritake, Tsukasa; Maeda, Takashi; Kawai, Kiyotaka; Takagi, Kenji; Kawai, Satoru; Kamiya, Satoaki

doi:10.1007/s10151-019-02010-0

Cited by 4 publications

(5 citation statements)

References 4 publications

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“…Although several technical notes have offered to ease SFM, it continues to be a challenging step at the time of laparoscopy (9)(10)(11). In a survey, surgeons have rated the di culty of the key components of laparoscopic rectal operations, resulting in the highest di culty score for SFM (12).…”

Section: Introductionmentioning

confidence: 99%

Prediction and Outcomes of Splenic Flexure Mobilization Duration during Laparoscopic Distal Colectomy for Colorectal Cancer: An Analysis of Operation Videos

Akyol,

Arslan,

Kocak

et al. 2023

Preprint

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Purpose: Splenic flexure mobilization (SFM) is a challenging step during laparoscopic colorectal operations. This study aims to inspect the predicting measures and consequences of lengthened SFM duration during laparoscopic distal colorectal cancer surgery. Methods: Patients underwent elective laparoscopic anterior or low anterior resection (AR or LAR) for distal sigmoid or rectal cancer were included. Data were abstracted from a prospectively designed database. A blinded observer to the patients and procedures watched the operation videos and tiered the steps of the procedures into 5 as follows: 1) medial-to-lateral dissection, 2) pelvic dissection, 3) dissection of the white line, 4) SFM, and 5) stapling, resection, extraction of the specimen and anastomosis. Patient and disease related measures predicting SFM duration and consequences of lengthened SFM duration were investigated. Results: A total of 105 patients (62 male, 59%) treated with AR (n=41) or LAR (N=64) were included to the study. No other patient or disease related features, but patients’ body mass index (BMI), weight and height were found to be significant predicting measures for lengthened SFM duration (p=0.0086, p=0.002 and p=0.43, respectively). The duration of SFM was correlating with the intervals of steps 1 (p=0.0013), 3 (p=0.0088) and 5 (p=0.04) and total operation time (p<0.0001). Lengthened SFM did not worsen postoperative measures including complications, hospitalization period and early oncological outcomes. Conclusions: Patients’ BMI, weight and height are the predicting measures for SFM duration at the time of laparoscopic distal colectomies. SFM duration shows a strong correlation with the durations of almost all other steps and total operation time but does not affect perioperative measures. Trial registration: E-10840098-772.02-61604 2.2.2019

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Section: Introductionmentioning

confidence: 99%

Prediction and Outcomes of Splenic Flexure Mobilization Duration during Laparoscopic Distal Colectomy for Colorectal Cancer: An Analysis of Operation Videos

Akyol,

Arslan,

Kocak

et al. 2023

Preprint

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“…For left-sided colon cancer, the cranial-first approach is one of the promising procedures for obtaining better surgical outcomes; it has been reported previously [2]. This approach involves dissection of the superior layer of the mesocolon and transverse mesocolon at the posterior border of the pancreas cranially; this makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and CME, which is the strongest advantage of this approach.…”

Section: Introductionmentioning

confidence: 99%

Cranial-first approach of laparoscopic left colectomy for T4 descending colon cancer invading the Gerota’s fascia

Ogura¹,

Kobayashi²,

Kawai³

et al. 2019

surg case rep

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BackgroundThe safety and feasibility of laparoscopic colectomy for T4 colorectal cancer remain controversial. We believe that setting a “Goal” that will guide the surgeons in returning from the deep layer could be the key to safe en bloc resection of neighboring organs. For descending colon cancer, the cranial-first approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision, which is the strongest advantage of this approach.Case presentationA 75-year-old woman was diagnosed with T4 descending colon cancer invading the Gerota’s fascia. We performed laparoscopic left colectomy using the cranial-first approach to set a “Goal” at the inferior border of the pancreas for safe resection of the Gerota’s fascia. The total operative time was 233 min, and the estimated blood loss was 98 ml. She was discharged after surgery without postoperative complications. Pathological findings revealed the invasion into the Gerota’s fascia, and the resection margin was negative for cancer.ConclusionsThe cranial-first approach of laparoscopic left colectomy appears to be safe and feasible and could be a promising method for selected patients with T4 descending colon cancer invading the Gerota’s fascia.

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“…A cranial-first approach preceding the splenic flexure mobilization has shown an advantage in reducing the risk of pancreatic and splenic injury. 1 Recently, the accessory middle colic artery (AMCA) has been recognized as an essential feeding artery to the splenic flexure. It is found in 6.6% to 48.9% of cases, [2][3][4][5][6] and patients typically have lymphatic flow from the splenic flexure along the AMCA.…”

mentioning

confidence: 99%

“…If necessary in some patients, to prevent pancreatic injury, we place the gauze on the cranial side of the transverse mesocolon before dissecting it, as recommended in a previous article. 1 Especially in an obese patient with thick fat tissue in the mesocolon, we partially dissect the mesocolon along the planned line for complete mesocolic excision and later communicate with the already dissected cranial plane, while the pancreas is identified through the gap formed at the site of dissection of the mesocolon. In the present case, we could easily identify the pancreas from the caudal side, and we did not use these methods.…”

mentioning

confidence: 99%

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Cranial-First Approach for Splenic Flexure Colon Cancer in Laparoscopic Complete Mesocolic Excision

Yamamoto

Fukuda

Okuchi

et al. 2023

Diseases of the Colon &Amp; Rectum

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Cranial-first approach for laparoscopic surgery with splenic flexure mobilization

Cited by 4 publications

References 4 publications

Prediction and Outcomes of Splenic Flexure Mobilization Duration during Laparoscopic Distal Colectomy for Colorectal Cancer: An Analysis of Operation Videos

Prediction and Outcomes of Splenic Flexure Mobilization Duration during Laparoscopic Distal Colectomy for Colorectal Cancer: An Analysis of Operation Videos

Cranial-first approach of laparoscopic left colectomy for T4 descending colon cancer invading the Gerota’s fascia

Cranial-First Approach for Splenic Flexure Colon Cancer in Laparoscopic Complete Mesocolic Excision

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