Robotic splenic flexure mobilization: A medial approach

This video was an entry for the KS National Robotic Surgery Awards-2020.

Abstract: Dr Narasimhaiah Srinivasaiah Apollo hospitals, Bannerghatta road, Bangalore.

Background: The mobilization of the splenic flexure is vital to gain length and create a tension free anastomosis in rectal cancer surgery. Various approaches have been described. Inframesocolic medial to lateral, supramesocolic and lateral to medial. In this video a preferred inframesocolic medial to lateral approach is demonstrated, in addition to the other two.

Video: The video shows the inframesocolic medial approach. Following skeletanisation of IMV, Dissection above the Todd’s fascia is continued. Key is to stay above the body of the pancreatic body and tail. A combination of sharp and blunt dissection takes you to the lesser sac following opening of the transverse mesocolon. The second part of the video shows the supramesocolic approach where omentum is released off the transverse colon. The third part of the video shows the lateral-to-medial approach. A combination of all the above helps in bringing down the splenic flexure successfully.

Results: All three approaches are robotically feasible and safe. The goal remains gaining adequate length and creation of a tension free anastomosis.

Conclusion: It is important for the surgeon to be familiar with all the three approaches and in a majority, a combination of all three approaches are utilized.

Narrated robotic surgery, with CT Scans, 05:10