Laparoscopic Approaches to Splenic Flexure Mobilization Tailored According to Disease- and Patient-Related Factors
Early 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.
29. November 2020 (online)
© 2020. Medical and Surgical Update Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J. Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 2008; 143 (08) 762-767, discussion 768
- 2 Brennan DJ, Moynagh M, Brannigan AE, Gleeson F, Rowland M, O’Connell PR. Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum 2007; 50 (03) 302-307, discussion 307
- 3 Katory M, Tang CL, Koh WL. et al. A 6-year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization. Colorectal Dis 2008; 10 (02) 165-169
- 4 Akiyoshi T, Kuroyanagi H, Oya M. et al. Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer. Surg Endosc 2010; 24 (11) 2749-2754
- 5 Farke S, Bouchard R, Blumberg C. et al. Mobilization of the splenic flexure: a standard in laparoscopic left colon and rectum resections!. Surg J 2010; 5: 31-35
- 6 Araujo SE, Seid VE, Kim NJ, Bertoncini AB, Nahas SC, Cecconello I. Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study. Arq Gastroenterol 2012; 49 (03) 219-222
- 7 Kye BH, Kim HJ, Kim HS, Kim JG, Cho HM. How much colonic redundancy could be obtained by splenic flexure mobilization in laparoscopic anterior or low anterior resection?. Int J Med Sci 2014; 11 (09) 857-862
- 8 Araujo SEA, Seid VE, Kim NJ, Bertoncini AB, Nahas SC, Cecconello I. Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study. Arquivos de gastroenterologia 2012; 49: 219-222
- 9 Ludwig KA, Kosinski L. Is splenic flexure mobilization necessary in laparoscopic anterior resection? Another view. Dis Colon Rectum 2012; 55 (11) 1198-1200
- 10 Taflampas P, Christodoulakis M, Tsiftsis DD. Anastomotic leakage after low anterior resection for rectal cancer: facts, obscurity, and fiction. Surg Today 2009; 39 (03) 183-188
- 11 Gezen C, Altuntas YE, Kement M. et al. Complete versus partial mobilization of splenic flexure during laparoscopic low anterior resection for rectal tumors: a comparative study. J Laparoendosc Adv Surg Tech A 2012; 22 (04) 392-396
- 12 Marsden MR, Conti JA, Zeidan S. et al. The selective use of splenic flexure mobilization is safe in both laparoscopic and open anterior resections. Colorectal Dis 2012; 14 (10) 1255-1261
- 13 Saber AA, Dervishaj O, Aida SS, Christos PJ, Dakhel M. CT Scan mapping of splenic flexure in relation to spleen and its clinical implications. Am Surg 2016; 82 (05) 416-419
- 14 Perrakis A, Weber K, Merkel S. et al. Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. Int J Colorectal Dis 2014; 29 (10) 1223-1229
- 15 Kim HJ, Kim CH, Lim SW, Huh JW, Kim YJ, Kim HR. An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection. Colorectal Dis 2013; 15 (02) e93-e98
- 16 Watanabe J, Ota M, Suwa Y, Ishibe A, Masui H, Nagahori K. Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging. Int J Colorectal Dis 2017; 32 (02) 201-207