Step by Step for hepatic flexure mobilization
Posted in Lectures on 8 December 2014
Published by Salvadora Delgado
Albert Wolthuis (Colorectal Surgery)
University Hospital of Leuven, Belgium
Main points of controversy in the treatment of colon cancer by laparoscopy are: the way of performing the dissection, medial to lateral or lateral to medial and surgical timing to follow (vessel section, avascular plane dissection of mesocolon and descent of angles).
In the literature and consensus guidelines of the Scientific Societies, it seems to be of a greater tendency to perform as first manoeuvre the vascular section (to decrease the release of neoplastic cells with tumor manipulation) continuing the dissection of the avascular plane of the mesocolon plane from medial to lateral plane and finally release of the angles. However, there is no scientific evidence that this form of addressing cancer influences the performance of an oncological resection or in survival of patients.
In the video Albert Wolthuis presented a dissection for right colon cancer, in which in the first instance the dissection of the lateral mesocolon is performed until the duodenum is identified, releasing the whole of the right colon, the second step is the vascular ligature and ends with the descent of hepatic angle.