Laparoscopic left-sided colectomy (mobilization of splenic flexure and sigmoidectomy)

Abstract

Laparoscopy is characterized by its ability to provide direct, magnified views of deep structures in narrow spaces and by the fact that laparoscopic observation and manipulation are carried out from foreground to background. It is logical, therefore, to perform laparoscopic surgery via a medial approach. Because laparoscopy requires coordination between the surgeon, first assistant surgeon (assistant), and second assistant surgeon (videoscopist), the procedure for creating an adequate operative field should be standardized. Under sufficient countertraction, the loose connective tissue between the mesocolon and retroperitoneal organs, such as the autonomic nerves, left ureter, left gonadal vessels, and pancreas, expands like a spider’s web and is recognizable as the dissectable layer. Through the medial approach and with cooperation between the three surgeons, the interior surface of the peritoneum on the left side of the upper mesorectum, the anterior lobe of the transverse mesocolon, and the splenocolic ligament can be fenestrated to communicate through to the left side of the rectum and colon, the omental bursa, and the lateral side of the splenic flexure, respectively. The deep dissection is performed to communicate with the lateral space from the medial side, which expedites the subsequent lateral approach.