Laparoscopic left colectomy with a lateral to medial dissection

Advances in minimally invasive surgical techniques, technology, and instrumentation have fostered the application of minimally invasive surgery to the management of colorectal surgery. Colorectal procedures through a laparoscopic, robotic or NOTES approach are feasible and appear to offer significant benefits in comparison to the open procedures. Reducing the abdominal trauma and the physiological impact may be key strategies in achieving optimal outcomes.
A safe transition from the current approach into the new technology is mandatory, as well as a full commitment of surgeons in the development and application of new technologies and procedures.

This video demonstrates the dissection of the vascular anatomy of the right colon for a right hemicolectomy. The surgeon uses a medial approach to mesenteric mobilization to show an excellent dissection of ileocolic, right and middle colic vessels.

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.

The appendicular mucocele is defined by a dilation of the appendix and an unusual accumulation of mucus within its lumen. It is a rare pathology which affects 0.25% of the population.
Its histological discovery is made during the postoperative phase in nearly 70% of cases. Appendicular mucoceles, which are secondary to a muco-secretive tumor, can potentially be a problem if they are malignant, especially in case of preoperative or intraoperative rupture, with a risk of gelatinous disease of the peritoneum.
The positive diagnosis is based on a histological study, which must be systematic, for all appendectomy specimens. Preoperatively, it is essential to recognize an appendicular mucocele, in order to properly adapt the surgical technique, and to potentially envisage a more global surgical resection technique.
We present the case of a 70-year-old man, treated in our unit for right iliac fossa abscess in which an explorative laparoscopy was decided upon after one month of medical treatment.