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Identification of the left ureter during an acute sigmoiditis with sidewall fixation

Laparoscopic sigmoid colectomy has become an acceptable method of surgical treatment for diverticulitis. However, during acute procedures, dissection is challenging. The objective of this film is to demonstrate the dissection performed during an acute sigmoid diverticulitis with attachment of the ureter at the level of the inflammation.

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Identification of the left ureter during an acute sigmoiditis with sidewall fixation

作者群

J Leroy, J Marescaux

摘要

Laparoscopic sigmoid colectomy has become an acceptable method of surgical treatment for diverticulitis. However, during acute procedures, dissection is challenging. The objective of this film is to demonstrate the dissection performed during an acute sigmoid diverticulitis with attachment of the ureter at the level of the inflammation.

關鍵字

left ureter, acute sigmoiditis, sidewall fixation, sigmoid colectomy, diverticulitis

媒體類型

手術影片

期間

04'04''

刊物

2010-12

普通的

最愛

Favorites Media

音訊

副標題

數位出版

WeBSurg.com, Dec 2010;10(12).
URL: http://www.websurg.com/doi-vd01en2977.htm

Identification of the left ureter during an acute sigmoiditis with sidewall fixation

1. Introduction 00'20''

The objective of this film is to demonstrate the dissection performed during an acute sigmoid diverticulitis with attachment of the ureter at the level of the inflammation.

2. Incision of sigmoid mesocolon 00'38''

The intervention is begun conventionally by the incision of the sigmoid mesocolon close to the colon using a medial approach. The Ligasure Atlas® device is used in this relatively adipose patient. In the present case, it is useful to resort to this type of instrument. The dissection is started fairly caudally close to the root of the mesorectum at the colorectal junction until reaching the rectum.

3. Lateral sigmoid dissection 01'23''

A lateral approach to the sigmoid colon is then used in order to take down its adhesions to the abdominal wall. The incision is sufficiently large to find oneself in a healthy area, especially to find the medial dissection area, which was initiated by means of the Ligasure Atlas® device. The freeing of the sigmoid colon is then pursued by staying in contact to the colon to make sure the ureter has been preserved. Attempts at identifying the ureter are then made in a relatively healthy region before continuing the dissection.

4. Ureter identification 02'24''

The ureter is identified using a medial approach. Very rapidly, one can observe that this ureter has been fixed and attracted by the inflammatory area. This accounts for the risks of such a dissection. It is therefore necessary to identify the ureter before continuing the dissection. It is clearly visible that the ureter is close to the fibrotic area. It is drawn to this fibrotic area, and especially so laterally.

5. Fibrotic area dissection 03'02''

Dissection is then pursued by controlling the ureter over its entire pathway. To do so, the inflammatory and fibrotic bands are divided. It is important to stay away from the ureter using back and forth movements from right to left. Divisions should be performed preferably in the sigmoid mesocolon at the level of inflammatory areas rather than on the pelvic wall. Contact to the colon, then to the rectum should be kept. Dissection is achieved distally from the rectal wall. Here, the left ureter is clearly visible. It is very close to the rectum, hence accounting for the importance of the dissection in contact to the rectal wall. Once the ureter has been freed from the upper rectum, division of the rectum can be carried out using a stapler by preserving the ureter.