5/28/2023 0 Comments Right colic flextureCT showed clinical T3N0M0, and that the right and left branches of the middle colic artery were separately arising from the SMA. The patient was a 63-year-old male with pathologically proven mid-transverse colon cancer. The aim of this video ( Figure 1) is to introduce a standardized flexure-mobilization first approach for laparoscopic transverse colectomy with the use of ICG for clarifying the vascular anatomy.įigure 1 Transverse colectomy using ICG with flexure-mobilization first approach ( 5). Many surgeons prefer to mobilize both flexures after completing lymph node dissection, but sometimes identifying the surgical plane is challenging because the surgical plane for both flexure mobilizations from the site of middle colic vessels can be unfamiliar and complicated. Therefore, it follows that using ICG in complicated vascular anatomy around the middle colic artery and SMA would be very helpful to make the anatomy clear.īoth hepatic and splenic flexure mobilizations are essential to achieving tension-free anastomosis in transverse colectomy. ICG is also very helpful in clarifying complicated anatomical structures including the biliary system and vascular system ( 3, 4). The main purpose of using ICG is to determine the flow of lymphatics and the status of perfusion ( 1, 2). Nowadays, indocyanine green (ICG) is widely used in many surgical fields. Technically, dissection around the middle colic artery is demanding because of the complicated vascular anatomy and anatomical variations. Due to these anatomical characteristics, the extent of lymph node dissection for transverse colon cancers should not only include the middle colic artery but also the inferior border of the pancreas, the middle colic vessels, the SMA and vein, and the greater omentum. Laparoscopic transverse colectomy is technically challenging, not just because of the low incidence of mid-transverse colon cancer, but also because the surgical procedure has yet to be standardized.Īlthough the mid-transverse colon is only supplied by the middle colic artery, the mesentery of the transverse colon is close to the superior mesenteric artery (SMA) and vein (SMV), the greater omentum, the pancreas, and the lesser sac. Received: Accepted: 22 July 2019 Published: 23 August 2019. Keywords: Laparoscopic transverse colectomy indocyanine green (ICG) transverse colon cancer Thus, the authors here detail a laparoscopic transverse colectomy using ICG and both flexure-mobilization first approach. Indocyanine green (ICG) is widely used in the surgical field not only for detecting lymph nodes and perfusion but also for clarifying anatomical structures like the vascular and biliary systems. Sometimes, however, flexure mobilization can be difficult after lymph node dissection around the middle colic vessels due to an unfamiliar surgical plane, while the direct approach to the middle colic artery is also technically challenging because of anatomical difficulty. Several surgical videos have introduced middle colic artery dissection as the first approach with both flexures being subsequently mobilized. To perform transverse colectomy, both flexures should be mobilized, and lymph node dissection around the middle colic artery should be performed. Abstract: Laparoscopic transverse colectomy is technically demanding because of the non-standardized surgical procedure and complicated vascular anatomy.
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