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Splenic flexure and left hemicolectomy
Published in Mark Coleman, Tom Cecil, Brian Dunkin, Laparoscopic Colorectal Surgery, 2017
Kathryn Thomas, Charles Maxwell-Armstrong, Austin Acheson
Alternatively the splenic flexure can be mobilised first from medial to lateral by identifying and dividing the IMV first and then entering the lesser sac from below. The omentum is retracted cephalad above the liver and spleen. Some right tilt can be useful to encourage the small bowel mesentery to fall to the right to allow identification of the duodenal-jejunal flexure and inferior mesenteric vein (Photo 8.7). The inferior mesenteric vein is mobilised and divided above the ascending left colic vein as it dives below the pancreas. We use either clips, or LigaSure bipolar diathermy to divide the vein (Photo 8.8). The lesser sac is opened above the pancreas and lateral to the middle colic vessels (Photo 8.9). This allows the transverse mesocolon to be mobilised off the pancreas. The vein is then lifted and the two areas of dissection can be connected to allow a medial to lateral dissection out over Gerota fascia and the pancreas up to the splenic flexure. The omentum is then detached from the transverse colon which can usually be achieved by sharp dissection with scissors and diathermy. In obese patients it may be easier to divide the gastrocolic ligament with LigaSure, starting medially and entering the lesser sac from above and moving out laterally. Finally the lateral attachments of the descending colon and splenic flexure are divided to complete the mobilisation.
Left colectomy - open
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Mary R Kwaan, David A Rothenberger
This procedure poses unique technical challenges because of the variable blood supply to the left colon and the relationship of the left colon to adjacent structures. The arterial blood supply to the left transverse and descending colon segments is usually dependent on an arcade of vessels arising in a variable pattern from the superior and inferior mesenteric arteries. This arcade generally includes the left branch of the middle colic artery that merges near the splenic flexure into an arcade of vessels arising from the left colic artery to create the marginal artery of Drummond. Venous drainage of the mid-transverse colon may flow from the middle colic vein to the superior mesenteric vein, while the descending colon venous flow is to the left colic vein into the inferior mesenteric vein as it ascends over the psoas muscle in the retroperitoneum ultimately reaching the splenic vein. Intraoperative assessment of this anatomy is essential for the surgeon to plan an R0 resection of the colon and its adjacent lymph node-bearing mesentery and to preserve well-vascularized ends of colon to perform a safe anastomosis without tension. If this is not possible, extended resections of the proximal colon or sigmoid colon may be necessary. Pathology in the left transverse colon and descending colon may involve adjacent intraabdominal viscera including the stomach, omentum, and spleen or retroperitoneal structures, such as the distal pancreas, left kidney, and ureter. Unplanned splenectomy is performed in up to 6 percent of left colon resections for a splenic flexure tumor because of inadvertent splenic injury.1 Left colon cancers can invade the retroperitoneum requiring en bloc resection of involved distal pancreas or left kidney and ureter. Crohn’s disease can cause retroperitoneal abscesses and fistulae.
Predictive Efficacy of Circulating Tumor Cells in First Drainage Vein Blood from Patients with Colorectal Cancer Liver Metastasis
Published in Cancer Investigation, 2022
Xiaoyu Yang, Xue Bi, Fang Liu, Jiafei Huang, Zhongguo Zhang
The first drainage vein of a colorectal tumor refers to the main branch of the anatomically first-named vein closest to the tumor, such as the ascending branch of the left colic vein or the S1 vein of the sigmoid colon. The distance of the vein from the primary tumor is generally less than 10 cm, and the diameter of the blood vessels is mostly between 2 and 5 mm, which is convenient for anatomical exposure and blood drawing operations. According to the characteristics of human anatomy, blood flowing through the tumor drains into the mesenteric vein through this vein and finally enters the liver. During the operation, we used a blood collection needle to draw 7.5 ml of venous blood from the first drainage vein (FDVB) of the colorectal tumor for CTC detection before cutting off the blood vessels.