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    Rardin, Craig A.: Laparoscopic Low Anterior Resection

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    Tad Schmitt
    This document summarizes two laparoscopic surgeries: a laparoscopic low anterior resection for a patient with worsening diverticulitis, and a laparoscopic right hemicolectomy for a patient found to have a cecal adenocarcinoma. It describes the surgical techniques for both procedures, including identifying and ligating relevant vessels, developing tissue planes, and resection and anastomosis. Key steps involve ligation of the inferior mesenteric artery and vein during the low anterior resection, and identification and division of the ileocolic artery and transection of the ileum and cecum during the right hemicolectomy.

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    Rardin, Craig A.: Laparoscopic Low Anterior Resection

    Uploaded by

    Tad Schmitt
    14 views2 pages
    This document summarizes two laparoscopic surgeries: a laparoscopic low anterior resection for a patient with worsening diverticulitis, and a laparoscopic right hemicolectomy for a patient found to have a cecal adenocarcinoma. It describes the surgical techniques for both procedures, including identifying and ligating relevant vessels, developing tissue planes, and resection and anastomosis. Key steps involve ligation of the inferior mesenteric artery and vein during the low anterior resection, and identification and division of the ileocolic artery and transection of the ileum and cecum during the right hemicolectomy.

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    Notes on colorectal surgeries

    Original Title

    colorec thurs

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    This document summarizes two laparoscopic surgeries: a laparoscopic low anterior resection for a patient with worsening diverticulitis, and a laparoscopic right hemicolectomy for a patient found to have a cecal adenocarcinoma. It describes the surgical techniques for both procedures, including identifying and ligating relevant vessels, developing tissue planes, and resection and anastomosis. Key steps involve ligation of the inferior mesenteric artery and vein during the low anterior resection, and identification and division of the ileocolic artery and transection of the ileum and cecum during the right hemicolectomy.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    14 views2 pages

    Rardin, Craig A.: Laparoscopic Low Anterior Resection

    Uploaded by

    Tad Schmitt
    This document summarizes two laparoscopic surgeries: a laparoscopic low anterior resection for a patient with worsening diverticulitis, and a laparoscopic right hemicolectomy for a patient found to have a cecal adenocarcinoma. It describes the surgical techniques for both procedures, including identifying and ligating relevant vessels, developing tissue planes, and resection and anastomosis. Key steps involve ligation of the inferior mesenteric artery and vein during the low anterior resection, and identification and division of the ileocolic artery and transection of the ileum and cecum during the right hemicolectomy.

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    Rardin, Craig A.

    41M scheduled at 9:00AM for laparoscopic low anterior resection.


    12/27: Scheduled for OR on January 11 due to his worsening LLQ abdominal pain,
    leukocytosis and dislodged drain, with inflammatory changes.
    12/29: History of complicated diverticulitis, presented to ED with complaints of
    worsening LLQ abdominal pain. First presented on 11/7 with a diverticular abscess, with CT
    drain placed on 11/8. Re-admitted after one month after accidental removal. Had another
    drain on 12/9. Has gotten worse.
    ½: Seen by IR and noted to have a persistent colonic fistula, with mild resistance.
    1/9: Was marked for possible stoma.

    Laparoscopic Low Anterior Resection


    Used for rectal cancer and severe diverticulitis.
    Dissection done through RLQ port, just inferior to inferior mesenteric artery, revealing
    retroperitoneal structures including the ureter. We are doing a high ligation, requiring the
    ureter to be swept down in a proximal or high ligation.
    Find base of the IMA (L3, supplies from left colic to upper part of rectum) coming off the
    aorta, mostly done with monopolar cautery. After IMA is identified, a Maryland is used to
    skeletonize and create a clean window on both sides at the takeoff from the aorta, ensuring a
    good lymph node harvest.
    Isolate inferior mesenteric vein and ligate this as well.
    After this, a section in the lateral plane is more straightforward. Use monopolar cautery
    and dissect just medial to the white line of Toldt (lateral reflection of posterior parietal
    peritoneum of abdomen over the mesentery of ascending and descending colon) as we
    approach the splenic flexure. Important to remain medial here to not enter Gerota’s fascia
    (renal fascia).
    Then dissect in lesser sac, dissecting omentum and working thru with monopolar
    energy, allowing for both dissection planes to meet at the edge of the splenic flexure. May have
    to carve through splenocolic ligament which can carry an unnamed vessel that can bleed.
    Pelvic Dissection
    Move to pelvic dissection through the holy plane, between presacral fascia (anterior
    aspect of the sacrum) and the mesorectal fascia. Dissection continues posteriorly, down
    bottom of the pelvic.
    Right peritoneal reflection in right gutter is dissected, moving back and forth from
    posterior to right. Working through Waldeyer’s fascia (presacral) to separate bottom of rectum
    from pelvic fascia.
    Use bipolar energy to open up mesorectum and the rectum – can carry all the way to
    the anorectal ring. Make a primary anastomosis or ileostomy if needed.
    One fire of an endo-GIA 60 stapler is often adequate, leaving the ano-rectal stump to
    retract above levator ani. An end-to-end anastomosis is done, opening EEA anterior to staple
    line, with end-to-end anastomosis low in the pelvis made. Can do a leak test.
    Medscape Notes
    Need to excise at least 5cm distal to a cancer. For diverticular, go to upper rectum
    where taenia coli coalesce.

    Taylor, Margaret
    Laparoscopic right hemicolectomy. Was admitted in late December for SOB and fatigue,
    was found to be anemic and have rectal bleeding. A colonoscopy was performed which found a
    mass – sampling detected adenocarcinoma in a cecal mass, moderately to poorly differentiated
    with focal signet ring features.
    Terminal ileum is identified, and mesocolon traced. By raising the TI, mesentery is
    draped over ileocolic artery, which supplies it. Find the takeoff of this artery at the inferior
    margin of the duodenum. Plane under mesentery is developed up to the hepatic flexure and
    distal to the TI, with ureter being seen.
    The mesocolon is then divided medial to the ileocolic vessel with an energy source. The
    ileum is transected 5cm proximal to the cecum with an endoscopic stapler – white line of Toldt
    is mobilized up to, and including, the hepatic flexure until original plane of dissection at the
    inferior margin of the duodenum is encountered.

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