Emilio Morpurgo, MD; Tania Contardo, MD; Barbara Termini, MD; Camillo Orsini, MD; Sara Maria Tosato, MD; Annibale D' Annibale, MD
Introduction: Take down of the splenic flexure is a crucial part of laparoscopic anterior resection. It allows a tension-free anastomosis and a proper exteriorisation of the specimen with the ligated origins of the inferior mesenteric vessels through a minilaparotomy located in the lower abdomen. The technique is shown in the video.
Methods: The patient is in Trendelemburg position, rotated to the right. The inferior mesenteric vein is divided; the mesentery of the left colon is detached from the Gerota; a hole is made in the mesentery of the transverse colon above the pancreas allowing the gas to enter the lesser sac; the mesentery of the flexure is detached from the pancreas in a mediolateral direction; the colon is detached from the omentum and the left abdominal gutter and the flexure mobilised.
Results: Out of 579 laparoscopic elective colorectal resections for cancer, 234 were for left colon cancers and 181 for rectal cancers. Mean operative time was 228±58 minutes for left colectomies and 284±78 minutes for low anterior resections; number of lymphnodes retrieved was 13±7, length of specimen 27±14 cm. Thirteen (5.6%) symptomatic leaks occurred in left colectomies and 19 (10.5%) in anterior resections. At mean follow up of 36 months global cancer related survival is 85%.
Conclusion: With the technique shown a complete laparoscopic take down of the splenic flexure is performed, allowing a tension free anastomosis and the retrievement of an oncologically adequate specimen through a low minilaparotomy.