Approaches to splenic flexure mobilization

Abstract

Mobilization of the splenic flexure remains one the most challenging steps of any colorectal operation (Mackenzie et al. Surg Endosc 27(8): 2704-2711, 2013). Splenic flexure mobilization is an integral component of sigmoid, left colon, and rectal resections, and is required for total abdominal colectomy. A thorough understanding of the anatomy of the left upper quadrant, particularly its relation to the tail of the pancreas and spleen, is critical for a clean anatomic dissection, whether for a proper oncologic splenic flexure resection or facilitating a tension-free, well-perfused colorectal anastomosis. Due to the complex anatomy and technical challenges, multiple approaches to splenic flexure dissection have been described with no clear best practice (Pisani Ceretti et al. BMC Gastroenterol 15(76), 2015). Single- and reduced-port laparoscopic approaches mimic multiport approaches, albeit with increased challenges pertaining to retraction and ergonomics. Standardizing techniques for splenic flexure mobilization is essential to provide a reproducible approach which can be applied to all disease states and body habitus while minimizing complications. In this chapter, we describe the approaches of splenic flexure mobilization in the minimally invasive reduced-port setting and our preferred technique.