Laparoscopic Colorectal Cancer Surgery 1st edition by Makio Mike ISBN 9811023200 9789811023200

1: Basic Principles

1.1 Introduction

1.2 Definition of the Terminology—Dissection, Cutting, Fusion, and Adhesion

1.2.1 The Concept of Dissection and Cutting

1.2.2 The Difference Between Adhesion and Fusion

1.2.3 The Concept of Dissection in Endoscopic Surgery

1.3 Peritoneal Configuration, Body Wall, and Intestinal Rotation in Foetal Life

1.4 Intestinal Rotation and Peritoneum

1.5 Relationship Between the Stomach and Transverse Colon—Particular Relationship at the Cen

1.6 The Presence of Histological Fascia

1.7 Vascular Anatomy and Lymph Node Dissection of the Colon [12]

1.7.1 Vascular Anatomy and Lymph Node Dissection of the Right Colon

1.7.2 Vascular Anatomy and Lymph Node Dissection of the Left Colon

1.7.3 Vascular Anatomy of the Splenic Flexure

1.7.4 Definitions of Surgical Treatments for Colon Cancer

1.8 Fascial Anatomy of the Umbilicus and the Method for Insertion of Hasson’s Cannula

1.9 Summary

References

2: Basic Approach

2.1 Basic Approach for Colorectal Cancer

2.1.1 Indication

2.1.1.1 Colon Cancer

2.1.1.2 Rectal Cancer

2.1.2 Marking of the Lesion and Preoperative Treatment

2.2 Basic Approach for the Operation

2.2.1 Patient Positioning

2.2.2 Cannula Positioning

2.2.3 Exposure of the Operative Field

2.2.4 Anatomical Landmarks and Searching in the Abdominal Cavity

3: Laparoscopic Sigmoidectomy

3.1 Introduction

3.2 Fundamentals Related to the Sigmoid Colon

3.3 Resection Range and Degree of the Lymph Node Dissection

3.4 Fascial Composition and Fusion Fascia of the Descending Colon and Sigmoid Colon

3.5 Operative Procedures (in Men)

3.5.1 Intraoperative Positions, the Trocar Site and Elimination of the Small Intestine

3.5.2 Operative Procedures

3.5.2.1 Dissection and Mobilisation of the Sigmoid Colon with the Medial Approach

Dissection and Mobilisation of the Sigmoid Colon from the Lateral Side

3.5.2.2 Lymph Node Dissection at the Root of the IMA

3.5.2.3 Dissection and Mobilisation of the Sigmoid Colon with the Lateral Approach (Supplement

Dissection and Mobilisation of the Sigmoid Colon from the Lateral Side

Dissection and Mobilisation of the Sigmoid Colon from the Medical Side

3.5.2.4 Dissection of the Dorsal Side of the Rectum

3.5.2.5 Division of the Sigmoid Colon or the Rectum at the Anal Side

3.5.2.6 The Procedure from the Auxiliary Incision

3.5.2.7 Anastomosis

3.5.2.8 Drain Insertion and Wound Closure

3.6 How to Understand the Fascial Composition

3.6.1 Deep Subperitoneal Fascia

3.6.2 Fascial Composition of the Dorsal Side of the Rectum – The Fascia Propria of the Re

3.6.3 Anatomical Landmarks in the Medial Approach

3.6.4 Anatomical Landmarks in the Lateral Approach

References

4: Laparoscopic Low Anterior Resection of the Rectum

4.1 Introduction

4.2 Resection Range and Degree of the Lymph Node Dissection

4.3 Fascial Composition and Fusion Fascia of the Rectum

4.3.1 Level of Aortic Bifurcation (Fig. 4.1 (1))

4.3.2 Level of the Promontorium (Fig. 4.1 (2))

4.3.3 Level of the Rectovesical Fossa (Fig. 4.1 (3))

4.3.4 Level of the Lateral Ligament (Fig. 4.1 (4))

4.3.5 Level of the Caudal Portion of the Terminal End of the Deep Subperitoneal Fascia (Fig.

4.4 Operative Procedures (in Men)

4.4.1 Intraoperative Positions, Trocar Site and the Elimination of the Small Intestine

4.4.2 Operative Procedures (Figure Shows the Case of Men)

4.4.2.1 Dissection in the Lesser Pelvis (Especially in the Retrorectal Space)

4.4.2.2 Incision and Dissection of the Ventral Side of the Rectum (Dissection of the Ventral

4.4.2.3 Dissection of the Right Lateral Ligament

4.4.2.4 Dissection of the Left Lateral Ligament

4.4.2.5 Further Dissection and Cutting of the Ventral Side of the Rectum (Division of Denonvi

4.4.2.6 Division of the Rectum

4.4.2.7 The Procedure from the Auxiliary Incision

4.4.2.8 Anastomosis

4.4.2.9 Insertion of a Drain and Closure of the Wound

4.5 Intersphincteric Resection of the Rectum (ISR)

4.5.1 Dissection the Anal Canal from the Cranial Side

4.5.2 Procedure from the Anus in the ISR

4.6 Fascial Composition of the Pelvis—Fascia Propria of the Rectum [2]

4.7 Current Issues and Proposal of the Fascial Composition of the Rectum [2]

4.7.1 Fascia Composition of the Sigmoid Colon

4.7.2 Definition of the Fascia Propria of the Rectum

4.7.3 Definition of the Rectosacral Ligament

4.7.4 Fascial Configuration in the Ventral Side of the Lower Rectum, and in Particular About

4.7.5 Fascial Configuration in the Lateral Sides of the Rectum

References

5: Laparoscopic Abdominoperineal Resection of the Rectum

5.1 Introduction

5.2 Stoma Site Marking and Preoperative Treatment

5.3 Operative Procedures (in Men)

5.3.1 Treatment of the Anus

5.3.2 Intraoperative Positions

5.3.3 Operative Procedures

5.3.3.1 Additional Dissection in the Lesser Pelvis (Especially in the Retrorectal Space)

5.3.3.2 Further Dissection of the Ventral Side of the Rectum

5.3.3.3 Division of the Sigmoid Colon

5.3.3.4 Operation from the Perinaeum

5.3.3.5 Endo-colostomy and Insertion of the Drain

5.3.3.6 Closure of the Port Puncture Wound and Maturation of the Stoma

5.4 Concept of Abdominoperineal Operation

5.5 Fascial Composition in the Parasacral Approach (Kraske Operation)

References

6: Laparoscopic Right Colectomy

6.1 Introduction

6.2 Resection Range and Degree of Lymph Node Dissection

6.3 Fascial Composition of the Right-Side Colon

6.4 Operative Procedure (in Men)

6.4.1 Incision of the Peritoneum in the Mesenteric Root

6.4.2 Dissection of the Fusion Fascia of Toldt from the Deep Subperitoneal Fascia

6.4.3 Linearization of the Ascending Colon and the Transverse Colon

6.4.4 Dissection and Division of the Hepatic Flexure of the Colon

6.4.5 Lymph Node Dissection of the Surgical Trunk

6.4.6 Small Auxiliary Incision

6.4.7 Intestinal Resection and Anastomosis

6.4.8 Wound Closure

6.5 Clinical Anatomy in the Medial-­Retroperitoneal Approach for Right Colon Cancer

References

7: Laparoscopic Left Colectomy

7.1 Introduction

7.2 Resection Range and Degree of the Lymph Node Dissection

7.3 Fascial Composition and Fusion Fascia of the Left Colon and the Splenic Flexure of the C

7.4 Operative Procedures (in Men)

7.4.1 Dissection and Mobilisation of the Sigmoid Colon Using the Medial Approach

7.4.2 Lymph Node Dissection at the Root of the IMA

7.4.3 Mobilisation of the Descending Colon

7.4.4 Approach from the Gastro-Colic Ligament

7.4.5 Small Auxiliary Incision

7.4.6 Intestinal Resection and Anastomosis

7.4.7 Wound Closure

7.5 Mobilisation of the Splenic Flexure of the Colon

References

8: Laparoscopic Subtotal Proctocolectomy

8.1 Introduction

8.2 Resection Range and Dgree of Lymph Node Dissection

8.3 Operative Procedures

Reference

9: Unresolved Fascial Composition

9.1 Considerations Regarding the Sites of Unresolved Fascial Composition

References