In this video we would like to show a pure laparoscopic sigmoidectomy with inferior mesenteric artery preservation.
This is a case of a 53-year-old woman with recurrent diverticulitis attacks, so it was decided to perform an elective laparoscopic sigmoidectomy.
We perform a medial-to-lateral mobilization using the inferior mesenteric vein as the initial landmark. The peritoneum under the inferior mesenteric vein is incised, and the space between the mesocolon and Gerota’s fascia is developed bluntly toward the abdominal wall, superiorly toward the inferior edge of the pancreas, and inferiorly toward the inferior mesenteric artery.
The inferior mesenteric vein is then divided. We preserve the inferior mesenteric artery by sectioning the sigmoid arteries just above the superior rectal artery.
Dissection of the inferior mesenteric artery at its origin with its surrounding tissue is needed to achieve full lymph node removal in the treatment of rectosigmoid cancer, but in the surgical management of diverticular disease, the inferior mesenteric artery is safely spared.
Moreover, skeletonization of the inferior mesenteric artery during a left hemicolectomy for diverticular disease preserves the natural blood supply of the colonic and rectal stump, and the ensuing performance of a healthy and well-nourished anastomosis may prevent anastomotic leakage and avoid low anterior rectal syndrome. We section the distal colon with a stapler at the promontorium level.
We open the rectum and extract the specimen transanally, avoiding any abdominal incision and performing in this way a pure laparoscopic procedure. We introduce the anvil transanally and close the rectal stump with stapler again. We perform a colostomy in the proximal colon, introduce the stem and close the colon with the stapler to finally create a side-to-end colorectal anastomosis.
The anastomosis was tested with a flexible endoscope in the operating room. No leak or bleeding was found.
The total operative time was 120 minutes. The postoperative hospital stay was uneventful and the patient was discharged three days after the procedure. The pathological analysis showed the presence of multiple diverticula with no malignancy.