scholarly journals Laparoscopic Approaches to Splenic Flexure Mobilization Tailored According to Disease- and Patient-Related Factors

2020 ◽  
Author(s):  
Melissa Kyriakos Saad ◽  
Elias Saikaly
Keyword(s):  
Colorectal Surgery ◽  
Splenic Flexure ◽  
Malignant Disease ◽  
Medical Literature ◽  
Laparoscopic Approach ◽  
Standard Approach ◽  
Surgical Approaches ◽  
Splenic Flexure Mobilization ◽  
Related Factors ◽  
Colorectal Surgeons

AbstractEarly in the 1990s, minimally invasive surgery manifested in laparoscopic surgery found its way to the field of colorectal surgery. Since then, a rising trend in utilizing laparoscopic approach in colorectal surgery, either for benign or malignant disease, is being noticed. In laparoscopic colorectal surgery, the most difficult and challenging step for colorectal surgeons is the mobilization of the splenic flexure. Laparoscopic mobilization of the splenic flexure is an area of debate, with no universally accepted gold standard approach. Multiple approaches have been described in the medical literature and no approach is considered the standard approach. Hence, colorectal surgeons should be familiar with all the different approaches and they should have the ability of utilizing a tailored splenic flexure mobilization approach modified according to patient- and disease-related factors. Herein, we review the different surgical approaches to laparoscopic splenic flexure mobilization that can be tailored to the surgeons needs according to patient- and disease-related factors.

scholarly journals Anatomical siting of the splenic flexure using computed tomography

2017 ◽  
Vol 99 (3) ◽  
pp. 207-209 ◽  
Author(s):  
L Meecham ◽  
A Brookes ◽  
CAW Macano ◽  
T Stone ◽  
M Cheetham
Keyword(s):  
Computed Tomography ◽  
Colorectal Surgery ◽  
Vertebral Body ◽  
Splenic Flexure ◽  
Accurate Method ◽  
Observer Agreement ◽  
Ct Scans ◽  
Anatomical Site ◽  
Vertebral Level ◽  
Colorectal Surgeons

INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (κ) value of 0.742 (95% confidence interval (CI), 0.463–0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: κ = 0.905 (95% CI, 0.785–0.961); CVBI: 0.951 (0.890–0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.

Cranial-first approach for laparoscopic surgery with splenic flexure mobilization

2019 ◽  
Vol 23 (7) ◽  
pp. 693-694 ◽  
Author(s):  
A. Ogura ◽  
R. Kobayashi ◽  
T. Aritake ◽  
T. Maeda ◽  
K. Kawai ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Splenic Flexure ◽  
Splenic Flexure Mobilization

scholarly journals Transischiorectal fossa approach for resection of pudendal nerve schwannoma: case report

2016 ◽  
Vol 25 (5) ◽  
pp. 636-639 ◽  
Author(s):  
Stephanie Chen ◽  
Brandon Gaynor ◽  
Allan D. Levi
Keyword(s):  
Pelvic Pain ◽  
Pudendal Nerve ◽  
English Language ◽  
Case Reports ◽  
Laparoscopic Approach ◽  
Direct Access ◽  
Surgical Approaches ◽  
Complete Relief ◽  
Pelvic Muscles ◽  
Intraoperative Electrophysiological Monitoring

Pudendal nerve schwannomas are very rare, with only two cases reported in the English-language literature. The surgical approaches described in these two case reports are the transgluteal approach and the laparoscopic approach. The authors present the case of a patient with progressive pelvic pain radiating ipsilaterally into her groin, vagina, and rectum, who was subsequently found to have a pudendal schwannoma. The authors used a transischiorectal fossa approach and intraoperative electrophysiological monitoring and successfully excised the tumor. This approach has the advantage of direct access to Alcock's canal with minimal disruption of the pelvic muscles and ligaments. The patient experienced complete relief of her pelvic pain after the procedure.

scholarly journals Lapco: national training programme for laparoscopic colorectal surgery

2009 ◽  
Vol 91 (8) ◽  
pp. 274-275 ◽  
Author(s):  
Mark Coleman
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Resection ◽  
Laparoscopic Colorectal Surgery ◽  
Clinical Excellence ◽  
Training Programme ◽  
Open Resection ◽  
Department Of Health ◽  
Action Team ◽  
Colorectal Surgeons ◽  
National Training

In 2006 the National Institute for Health and Clinical Excellence issued guidance that laparoscopic resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable. Due to the lack of trained colorectal surgeons a waiver was issued, which is due to be reviewed in September 2009. In 2007 the Cancer Action Team (CAT) at the Department of Health (DH) instituted the national training programme (NTP) for laparoscopic colorectal surgery (LCS) for colorectal consultants in England. The intention is to provide all suitable patients with bowel cancer in need of resection, access to a trained surgeon for laparoscopic resection. The programme is funded by the CAT.

Splenic flexure mobilization in rectal cancer surgery: do we always need it?

2018 ◽  
Vol 71 (3) ◽  
pp. 505-513 ◽  
Author(s):  
Francesco Ferrara ◽  
Giuseppe Di Gioia ◽  
Daniele Gentile ◽  
Giulia Carrara ◽  
Davide Gobatti ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Splenic Flexure ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Splenic Flexure Mobilization
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