What are the key milestones in laparoscopic left hemicolectomy?

Updated: Apr 13, 2020
  • Author: David B Stewart, Sr, MD, FACS, FASCRS; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

No single best approach or series of individual steps is recommended for safely performing a laparoscopic left colectomy; however, for pedagogic purposes, the following may be considered to be the key milestones of the surgical procedure:

  • Sigmoid colon mobilization - Identification of the left ureter; ligation of the inferior mesenteric artery (IMA)
  • Mobilization of the descending colon
  • Mobilization of the splenic flexure
  • Proximal and distal transection of the colon with an endoscopic stapler
  • Exteriorization of the specimen
  • Construction of the anastomosis

The order in which these steps are taken should not be viewed as set in stone. The order listed above is the one preferred by the author because it identifies the left ureter earlier in the course of the operation.


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