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Tips and tricks: preservation of superior rectal vessels using the new LigaSure Advance

Authors

Abstract

This video describes an elective laparoscopic sigmoidectomy for benign disease with the aid of the new Ligasure Advance. This 5mm laparoscopic electrosurgical instrument incorporates both a monopolar and tissue fusion (bipolar) function.

Classification

tips and tricks

Keywords

rectal superior vessel preservation, new Ligasure Advance, tips and tricks

Media type

Duration

05'20''

Publication

2008-06

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Audio

Subtitles

E-publication

WeBSurg.com, Jun 2008;8(06).
URL: http://www.websurg.com/doi-vd01en2236.htm

Tips and tricks: preservation of superior rectal vessels using the new LigaSure Advance

1. Case presentation 00'22''

We present the case of an elective sigmoidectomy due to benign disease and show the advantages of the new Ligasure Advance when performing this procedure. As in every sigmoidectomy, an adequate exposure facilitates a medial dissection. To improve exposure, the patient is placed in Trendelenburg position with a mild tilt to the right.

2. Dissection and division of the mesentery (medial approach) 00'43''

The first step is the vascular approach, this means we will perform a medial dissection. In this case, preservation of the superior rectal vessels is indicated. We begin by dividing the peritoneum and the mesocolon with the Ligasure Advance 5 mm, this instrument is an adequate electrosurgical instrument that incorporates both monopolar and tissue fusion (bipolar) functionalities. Tissue structures may be divided by the deployment of a mechanical knife that can be found within the shaft of the instrument and extends forward in a slot within the jaws. Thanks to this dual functionality, it is no longer necessary to constantly change instruments, thus making the procedure more efficient and shorter. In this type of surgery, vascular preservation is important and we show this by preserving the superior rectal vessels. This becomes evident by retracting medially the rectosigmoid junction; This manoeuvre allows us to dissect and isolate the superior rectal vessels and to continue with the colon dissection.

3. Preparation of the colorectal junction 02'50''

We continue the dissection up to the level where we plan to make the resection. As you can see, with monopolar cautery we can continue the dissection in a secure and adaptable way.

4. Distal transection 03'08''

With an EndoGIA linear stapler (blue cartridge), we divide the colon distally.

5. Lateral mobilization of the colon 03'19''

We retract the sigmoid up to the midline in order to place a more suitable traction and dissect the colon of its lateral attachments. During this step, we must avoid injuring the genital vessels and the left ureter. An adequate freeing of the colon ensures a tension-free anastomosis.

6. Anvil insertion 04'07''

We prepare the proximal part of the sigmoid by resecting the mesocolon up to the division point. We divide the colon and introduce the anvil through an enlarged suprapubic trocar incision.

7. Intracorporeal re-anastomosis 04'32''

To prepare the anastomosis, we introduce a circular stapler through the rectum and perforate the mechanical suture line and proceed to assembling the system. We check that there are no twists and continue to perform the colo-colonic end-to-end anastomosis in a mechanical fashion. We check the patency of the anastomosis by performing an air test.

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