{"paper_id":"2312736f-acfb-4337-955c-52840fcb8dc9","body_text":"VIDEO\nSegmental left colectomy: a modified caudal-to-cranial approach\nMarco Milone 1 • Francesco Milone 1\nReceived: 2 July 2016 / Accepted: 8 July 2016 / Published online: 21 July 2016\n/C211Springer Science+Business Media New York 2016\nAbstract\nBackground We have designed a modified caudal-to-cra-\nnial approach to perform laparoscopic left colectomy pre-\nserving the inferior mesenteric artery for benign colorectal\ndiseases.\nMethods IRB approval and informed consent have been\nobtained. A dissection is conducted to separate the\ndescending mesocolon of the Gerota’s plan from the\nmedial aspect to the peritoneal lining to the left parietal\ngutter. The peritoneal layer is incised parallel to the vessel\nand close to the colonic wall. The dissection is continued\nanteriorly up to reach the resected parietal gutter. A\npassage into the mesentery of the upper rectum is created\nfor the allocation of the stapler and the dissection of the\nrectum. These maneuvers permit to straighten the mesen-\ntery simplifying the identification and cutting of the\nsigmoid arteries. A caudal-to-cranial dissection of the\nmesentery is performed from the sectioned rectum to\nthe proximal descending colon by a sealed envelope\ndevice. It can be very useful to mobilize the colon in any\ndirection: laterally, medially, or upward. The dissection is\nperformed along the course of the vessel up to the proximal\ncolon, with progressive sectioning of the sigmoid arterial\nbranches. The specimen is extracted by a pfannenstiel\nincision. The anastomosis is performed transanally with a\ncircular stapler according to Knight–Griffin technique.\nResults We performed a laparoscopic segmental colec-\ntomy using this approach for 21 patients with benign sig-\nmoid lesions: 13 diverticulitis, 3 flat polypoid lesions (no\nlift-up sign), and 5 bowel endometriosis. The mean oper-\native time and blood loss were 161.4 ± 15.7 min and\n50 ± 40 ml, respectively. There were not a single con-\nversion to open surgery and no any leakage or stricture.\nOnly 2 cases of intraluminal bleeding and 1 case of wound\ninfection (treated conservatively) were observed.\nConclusion We consider this approach to be safe and\nuseful for segmental colectomy to be performed sectioning\nthe sigmoid artery close to the colonic wall.\nKeywords Left colectomy /C1Segmental /C1Caudal to\ncranial /C1Diverticulitis /C1Bowel endometriosis /C1Polypoid\nlesions\nCompliance with ethical standards\nDisclosures Marco Milone and Francesco Milone have no conflicts\nof interest or financial ties to disclose.\nElectronic supplementary material The online version of this\narticle (doi: 10.1007/s00464-016-5100-x) contains supplementary\nmaterial, which is available to authorized users.\n& Marco Milone\nmilone.marco.md@gmail.com\n1 Department of Surgical Specialities and Nephrology,\nUniversity of Naples ‘ ‘Federico II’ ’, Via Pansini 5,\n80131 Naples, Italy\n123\nSurg Endosc (2017) 31:1487\nDOI 10.1007/s00464-016-5100-x\nand Other Interventional Techniques","source_license":"public-domain-us","license_restricted":false}