LEFT HEMICOLECTOMY WITH PRESERVATION OF THE INFERIOR MESENTERIC VEIN THROUGHOUT ITS ENTIRE LENGTH

68 years old, female. Complaints of dark stools and positive occult blood test. No changes upon examination. Colonoscopy showed a polypoid, ulcerated lesion in the proximal descending colon, 30 mm, with endoscopic tattooing and histopathology consistent with adenocarcinoma. Staging exams: CEA 1.85, chest CT unremarkable, abdominal/pelvic CT showed parietal thickening at the splenic flexure, 2.2 cm. Laparoscopic left hemicolectomy was performed with intracorporeal anastomosis and preservation of the inferior mesenteric vein. The patient progressed well and was discharged on the 4th postoperative day. Surgical pathology: invasive and ulcerated adenocarcinoma, free margins, pT3pN0(0/20) lymph nodes. The patient is under oncological follow-up. The video shows a laparoscopic left hemicolectomy, with the patient positioned in the right lateral decubitus position. The retroperitoneal dissection began from the inferior mesenteric vein, with reference to the Treitz angle, detaching the mesocolon from Gerota's fascia and the pancreas, providing access to the retrocavity of the omentum. Preservation of the inferior mesenteric vein throughout its length was chosen. Dissection continued to the splenic flexure, freeing the left paracolic gutter. The tumor in the proximal descending colon was sealed at the origin of the left colic artery, preserving the inferior mesenteric artery and the left branch of the middle colic artery at its origin. The proximal and distal margins of the tumor were defined, the colon was sectioned, and an intracorporeal latero-lateral anastomosis was performed with closure of the breach using V-Loc 3.

Discussion Cancers of the distal transverse colon, proximal descending colon, and splenic flexure account for <10% of all colorectal cancers. Left hemicolectomy is the procedure of choice, as studies suggest that lymphadenectomy is adequate and sufficient with ligation of the left colic artery and the left branch of the middle colic artery at their origin. However, ligation of the inferior mesenteric vein is not performed for oncological purposes, but rather for better mobilization of the colon to achieve a tension-free anastomosis. If the ligation of the inferior mesenteric vein is close to its root, it may impair venous return. Colonic ischemia after surgery is a serious complication resulting from arteriosclerosis, functional disorders, and venous congestion due to poor blood circulation

Conclusion Venous congestion may result in anastomotic dehiscence, worsening morbidity and mortality of the procedure. Therefore, this technique aims to improve venous return and reduce rates of late dehiscence.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025