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Transverse colon resection for a mid-transverse colon cancer

This video demonstrates a transverse colectomy for a mid transverse colon cancer. The surgeon mobilizes and divides the middle colic vessels at their origin and preserve all the right- and left- sided vessels. A resection of the mid segment of transverse colon with adequate margins on either side of the tumor is carried out and extracorporeal anastomosis is made between proximal and distal end through a transverse suprapubic incision used to extract the specimen. In this case, the surgeon chose to do a transverse colectomy in a patient with redundant transverse colon, alternatively an extended right colectomy could have been carried out.

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Transverse   colon   resection   for   a   mid-transverse   colon   cancer

作者群
J Leroy
摘要
This video demonstrates a transverse colectomy for a mid transverse colon cancer. The surgeon mobilizes and divides the middle colic vessels at their origin and preserve all the right- and left- sided vessels. A resection of the mid segment of transverse colon with adequate margins on either side of the tumor is carried out and extracorporeal anastomosis is made between proximal and distal end through a transverse suprapubic incision used to extract the specimen. In this case, the surgeon chose to do a transverse colectomy in a patient with redundant transverse colon, alternatively an extended right colectomy could have been carried out.
分類
controversial cases
關鍵字
transverse colon cancer, transverse colectomy, laparoscopic
媒體類型
期間
13'00''
刊物
2004-09
普通的
最愛
Favorites Media
音訊
en tw
副標題
en
數位出版
WeBSurg.com, Sept 2004;4(09).
URL: http://www.websurg.com/doi-vd01en1261e.htm

Transverse   colon   resection   for   a   mid-transverse   colon   cancer

2. Case presentation 00'19''
This is the case of a 44-year-old female patient who presented with a stricture of the transverse colon. This stricture was discovered after investigation performed after an episode of a lower GI bleeding. Colonoscopy and biopsy showed a malignant tumor. The 1st trocar is placed 3 to 4 fingerbreadths superior to the pubic symphysis. There’s a 10 to 12mm trocar that is used for the laparoscope and that will provide a good caudad to cephalad view of the abdominal cavity. There are two 5mm operating trocars. One is placed in the right lower quadrant at the intersection of the right mid-clavicular line and of the horizontal line running superior to the anterior superior iliac spines. The other trocar is inserted through the rectus sheath medial to the epigastric vessels in the left lower quadrant. These trocars will converge towards the target, which is in the mid-transverse colon. Thorough visual exploration of the abdomen is performed to assess tumor extension followed here by endoscopic liver ultrasound. Both were normal and showed no tumor extension in this patient. The greater omentum and transverse colon are retracted cephalad. The tumor is located here at the proximal to mid-transverse colon. Enlarged lymph nodes can be identified in the transverse mesocolon. The 1st operative step is the cephalad retraction of the greater omentum and transverse colon in order to expose the base of the transverse mesocolon. The patient is put in reverse Trendelenburg position and the small bowel can be retracted away from the operative field and positioned in the lower quadrants. The pancreas, duodenum, and the right colic vessels can be identified. The next step is the vascular approach. The exposure as performed gives an optimal view of the base of the transverse mesocolon and of the vessels at their origin. The peritoneum is opened sharply towards the lesser sac until the anterior surface of the pancreas is visible. It is opened from left to right and the vessels can be easily seen. The base of the transverse mesocolon is now opened and dissection is carried on anterior to Toldt’s fascia in the avascular plane. We can now identify the left colic vein. We can also identify the gastrocolic venous trunk of Henlé. Dissection is performed in the avascular plane. This is the superior mesenteric vein and we can also see the right and the middle colic veins. All these vessels can be identified at their origins. The adipose tissue that is found at the base of the mesocolon is clipped before being divided in order to achieve perfect lymphostasis. Dissection is carried in the plane anterior to the pancreas and into the lesser sac until the stomach is reached. The middle colic vessels are clipped and divided at their origin. Here are the superior mesenteric vein and artery, the pancreas, the gastrocolic trunk of Henlé. All vessels have been divided at their origin. The omentum is divided sharply near the anticipated distal resection line. The plane between the transverse colon and greater omentum is divided and afterwards the gastrocolic ligament is divided until the stomach is reached. The right gastroepiploic vessels are preserved. The stomach can be seen on the right of the screen. The omentum is pushed in the right superior quadrant and this will be the distal margin of resection. The tumor is far away and we divide the left branches of the middle colic vessels and the mesocolon along these vessels to ensure proper oncologic resection. The distal resection line is here and is prepared. It is located at the distal transverse colon just proximal to the splenic flexure. The linear stapler is fired here to divide the colon and another linear stapler is fired at the proximal resection line, which is proximal to the hepatic flexure. The resected colon and omentum are placed in a large retrieval bag to avoid tumor spillage. It will later be brought out through the suprapubic incision. The retrieval bag is tightly closed; then the splenic flexure is mobilized in order to allow future and easy exteriorization of both ends of the colon through the suprapubic incision that will be performed later. The anastomosis will be performed extracorporeally. A 5mm suprapubic incision is performed and covered with a plastic wound protector. After extraction of the specimen, the bowel ends are pulled up to the skin and an extracorporeal side-to-side stapled anastomosis is performed. Both bowel ends have previously been anchored to each other by a stay suture to avoid twisting. The anastomosis is returned into the abdominal cavity. It shows no twisting, no tension, and a good vascular supply.