WebSurg中文版尚未完成，翻譯工作進行中！

Splenic flexure freeing for sigmoid colon resection

WebSurg是個虛擬大學，可在世界各地透過網路取得。我們的目標是提供外科醫師、科學協會及醫學產業第一個腹腔鏡及其最新發展之線上持續醫學教育的平台，包括NOTES和機器人手術。

瀏覽全世界
虛擬大學
繁體中文 ▼

Splenic   flexure   freeing   for   sigmoid   colon   resection

作者群
J Milsom, S Vartolomei
關鍵字
operation,sigmoidectomy,spleen,sigmoid colon resection
媒體類型
期間
13'00''
刊物
2004-09
普通的
最愛
Favorites Media
音訊
en
副標題
en
數位出版
WeBSurg.com, Sept 2004;4(09).
URL: http://www.websurg.com/doi-vd01en1008e.htm

Splenic   flexure   freeing   for   sigmoid   colon   resection

1. Case presentation 00'17''
Here’s the pedicle. So down here I’ll just divide straight on out the only vessels that are here are the marginal, down here there’s the vein and artery, it comes straight on out here, we know this has not been irradiated here yet; this part of the colon will likely be the part that we transplant down. This, I wouldn’t want to use because it has almost certainly been irradiated. Remind me before we go to the pelvis that we want to take a biopsy and maybe we should get a frozen on that liver area. This is the splenic flexure of the colon. We come up to the wall of the colon and then we just transect the bowel. Later we will hold up the colon with one of those Prolenes that I mentioned. Hold this up again. Don’t grab the bowel, just grab the epiploic appendix. Lift that up. I want to come through the bowel here and then across the other side. You can drop that down. Grab right about there. Now as far as cancer is concerned, we can come in and look closely. Drop that now. The reason these are great is because its fast. When I’m on the IMA, I’m worried about constantly arching off at something like this, and now I’m not. I don’t tend to use the Ligasure unless I get a big bleeding. You can see this is stuck right up inside of this. The colon is OK. This is where the scissors are really nice because there are no real vessels in there and we have to get this. We have to be precise. This can come off. See if I can reach over this. The colon is OK. We don’t want to injure the colon at all. Now we’re just taking down the last bits. You can see here there is a role for different energy sources. Each one of them may have a role, sharp dissection with the scissors. You can just use scissors as a holder. Here’s the colon flopping back on itself. We’re just taking off what’s attached just here. The spleen is getting further and further away. I go a little further away and then see if you can grab here. We have a very compliant colon so it’s interesting for the anastomosis. It’s important for the functional results. For the other patient, you ended up making a J-pouch and a colo-anal stapled low anastomosis. I keep ligatures and exert traction on the rectal stump. Usually I push the perineum and it’s not the same. To the left now. Where is the end, we didn’t have the end before. Yes it seems better, I agree.