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Cancer of the descending colon: laparoscopic left colectomy

This video clearly demonstrates the laparoscopic performance of left hemicolectomy for cancer.

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Cancer   of   the   descending   colon:   laparoscopic   left   colectomy

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摘要
This video clearly demonstrates the laparoscopic performance of left hemicolectomy for cancer.
關鍵字
媒體類型
期間
27'00''
刊物
2008-05
普通的
最愛
Favorites Media
音訊
en
副標題
en
數位出版
WeBSurg.com, May 2008;8(05).
URL: http://www.websurg.com/doi-vd01en2336.htm

Cancer   of   the   descending   colon:   laparoscopic   left   colectomy

2. Operation commences with adhesiolysis for exposure 01'36''
We have the small bowel and the sigmoid, a very long and vertical sigmoid, it is not stuck to the left. There is a long loop. Before I have pushed the omentum. We see the sigmoid finishing in the pelvis and going all the way here, and here is the descending colon. This position is due to fixations, this is the duodenojejunal junction. We have exposed with a limited Trendelenburg, we don’t remove the loop from the pelvis, first we will free the adhesions of the sigmoid loop. First, we have to understand the anatomy before freeing the adhesions. Do you always start by mobilizing the sigmoid or do you free up the splenic flexure first? I never begin with the mobilization of the splenic flexure. In this case, it is different because the tumor is very high but it is not always necessary to mobilize largely the sigmoid to have a good resection and a tension-free anastomosis. When we do the mobilization, it is to have a tension-free anastomosis, it’s not to do an oncologic resection. We have now freed the sigmoid loop, we have the duodenojejunal junction, we have the descending colon. I think it is good to do a left colectomy in this case because we have a very long and flexible colon. We will expose some more by increasing the Trendelenburg angle. Where do you think this tumor is because in these very long colons? The tumor is at the junction between the descending colon and the beginning of the sigmoid loop. The clips which have been placed endoscopically, will it make any difference for the surgeon? It is mainly the position of the clip and the X-ray and the anatomy of the patient concerning the sigmoid loop. We now begin the procedure.