In your opinion, what are the best indications for laparoscopic hand-assisted surgery?

In the current surgical practice, surgeons are increasingly faced with obese patients in different conditions. In this lecture, Dr. Nahas presents the challenge of obesity in colorectal surgery.

This video demonstrates a right hemicolectomy for a large cancer at the hepatic flexure. The patient has had a cholecystectomy and an appendectomy in the past and the adhesions make the case more difficult. The surgeon uses a medial approach to mobilize and divide the ileocolic vessels and the right branch of the middle colic. After full mobilization of the right colon, it is exteriorized through a small transverse incision at the umbilicus and an end-to-side anastomosis is made with an EEA stapler. The mesenteric window is not closed.

This video demonstrates the technique of medial approach to mesenteric mobilization and vascular dissection during a left hemicolectomy. The surgeon demonstrates the principles of trocar placement and internal retraction without the use of Trendelenburg.
This video is intended to provide basic review of medial mesenteric mobilization of the left colon.

This video demonstrates a right hemicolectomy for pT2 N0 M0 adenocarcinoma at the level of the caeco-ascending junction using a medial approach. The medial approach includes a primary vascular access, dissection into Toldt’s area and total freeing of the right colon. Once the terminal small bowel and the transverse colon have been divided at the junction of the proximal middle third, an isoperistaltic side-to-side anastomosis is carried out using a 60mm Endo-GIA linear stapler. The introduction site and the mesenteric window are re-approximated using a PDS 2/0 suture.

The first single port colorectal procedure was described in 2008. It is feasible but only in selected cases. In this lecture, Dr. Costedio presents the Cleveland Clinic experience.

In this lecture, Cristiano Huscher, MD, FACS, FRCS presents the technical details of a splenic flexure mobilization. He shows the port and patient positioning. All the surgical steps are detailed through the use of videos and anatomical notes.

The objective of this film is to demonstrate a fully laparoscopic original technique for the restoration of the ileorectal continuity after total colectomy for colonic obstruction in a pT4aN0M0 advanced colonic cancer which was operated on 10 months earlier (Hartmann procedure) and then managed by chemotherapy.

The objective of this film is to demonstrate a technique of coloproctectomy for disseminated polyposis in a young female patient who presented fairly massive bleedings. Her polyposis was discovered but did not have any known family history. Technical details and all steps of the dissection are clearly exposed.

Background: Single incision laparoscopic left hemicolectomy is a feasible procedure. A suprapubic access allows to offer satisfactory cosmetic results in case of an extended scar due to a large tumor. An intracorporeal circular mechanical anastomosis is the most common type. A manual anastomosis is feasible and allows to control lumen opening, potential bleeding, and overall to overcome the difficulty of transanal stapler insertion in case of high rectal transection.
Video: This video shows two different types of manual colorectal anastomosis, through a right suprapubic access.
1) Double-layer end-to-end
2) Monolayer end-to-end
Results: After an appropriate learning curve, time to perform the manual anastomosis is 40 minutes.
Conclusions: Different colorectal anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire left hemicolectomy, please click here.