Left hemicolectomy, open, curative

Median skin incision with left circumcision of the navel. Transection of subcutaneous fat tissue and fascia with diathermy.

Insertion of a drape and a retractor. Then determine the tumor size and location: The tumor is palpable just below the left flexure. Subsequently, review the abdomen to exclude metastases.

The proximal resection margin depends on the location and size of the tumor. After identifying the middle colic artery, loop the transverse colon slightly distal to it. In the present case, the middle colic artery is not centrally resected due to the advanced age and the distant location of the tumor.

The small intestine is held laterally to the right; the descending colon and sigmoid colon are released from the lateral adhesions. In doing so, at the level of the tumor, the plane of dissection must be led out of the peritoneal fold, as the tumor appears to be penetrating the serosa.

Opening of the omental bursa by detaching the greater omentum from the transverse colon to the left of the planned resection site. Transection of the splenocolic ligament with clamps for mobilization of the left flexure.

Detachment of the greater omentum from the stomach including the gastroepiploic arcade.

Note: Including the gastroepiploic arcade in left hemicolectomy is not strictly necessary, but is done here for radicality reasons.

Divide the greater omentum from its free edge towards the oral resection margin between Overholt clamps.