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Hemicolectomy left, open, curative - general and visceral surgery
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Determining the proximal resection margin
The upstream resection margin depends on the size and location of the tumor. After identifying the medial colic artery encircle the transverse colon slightly downstream of the artery. Because of the advanced age and distant tumor in the present case, this structure will not be included in the resection.
Mobilizing the descending colon and sigmoid
Entering the omental bursa
Open the lesser peritoneal sac by dividing the greater omentum off the transverse colon to the left of the planned margin of resection. In order to mobilize the splenic flexure, divide the splenocolic ligament between clamps.
Note: The omental bursa may also be opened by dividing the gastrocolic ligament superior to the colon to the left of the proximal resection margin.
Dividing the greater omentum off the stomach
Transecting the greater omentum
Freeing the splenic flexure
Dividing the left colic vein
Identify the primary vessels. Since it is not planned to divide the inferior mesenteric artery and vein close to their origin, thereby sparing the blood supply of the sigmoid colon, free the duodenum from the mesocolon and expose the inferior mesenteric vein. Then expose and divide the left colic vein close to its origin.
Dividing the left colic artery
Expose the left colic artery Determine the distal resection margin in the middle of the sigmoid.. Divide the mesentery step by step while including in the resection as much of the lymphatics as possible. First dissect and and divide the lymph nodes down to the trunk of the left colic artery. Divide the left colic artery while sparing the superior rectal artery.
Dividing the mesocolon
Transecting the colon
Anastomosing the colon
Drainage and wound closure