REV ARGENT COLOPROCT | 2024 | VOL. 35, N
o
2 VIDEO
STEP-BY-STEP LAPAROSCOPIC TRANSVERSE COLECTOMY Barbosa A, et al.
Laparoscopic segmental resection of the transverse colon.
Step by step surgery
Alejandro Barboza, Noelia Brito, Fabiana Domínguez, Federico Durán, Marcelo Viola
Médica Uruguaya Corporación de Asistencia Médica, Montevideo, Uruguay
Keywords: coloproctology, segmental resection, transverse colon,
colonic polyps, laparoscopic approach.
INTRODUCTION
Colonic polyps are highly prevalent in the general popula-
tion. Their importance lies in being potential precursors of
colorectal cancer.
1,3
For its management, endoscopy plays a
fundamental role, not only in reaching diagnosis, but also
often being therapeutic by allowing resection.
Surgery is reserved for patients with invasive malignant
lesions requiring en bloc resection or polyps, with or with-
out suspicious features, that cannot be safely removed
endoscopically.
2
The proven advantages of laparoscopic
colorectal surgery make it the gold standard for both benign
and malignant conditions. This approach has been evolving
over the last decades, with multiple studies validating its
oncological safety.
4
Not all patients are candidates for this
approach; However, not all patients are candidates, and the
choice depends on factors such as team experience, surgery
complexity, and patient condition, requiring an individual-
ized decision-making process.
Undoubtedly, one of the most complex laparoscopic proce-
dures in colon surgery is exclusive transverse colectomy.
4,5
It requires, high knowledge of the region's anatomy and
advanced surgical expertise for safe technical and oncologi-
cal outcomes.
DESCRIPTION
The experience of our center in the treatment of a 61-year-
old male patient with a colonic polypoid lesion with sus-
pected malignancy, unresectable via endoscopy, is present-
ed. During the laparoscopic approach the endoscopic tattoo
of the lesion was identified in the distal transverse colon.
The inferior mesenteric vein was ligated. A medial to lateral
approach was performed and the splenic flexure was mobi-
lized. The left branch of the middle colic artery was ligated.
The gastrocolic ligament was divided and the transverse
mesocolon was ligated with bipolar equipment. The proxi-
mal and distal transverse colon was transected with a linear
stapler and a side-to-side stapled anastomosis was per-
formed. The pathology reported a pT1N0 adenocarcinoma
without unfavorable microscopic features.
CONCLUSIONS
Laparoscopic segmental transverse colectomy is a complex
technique that an experienced team can perform with tech-
nical and oncological safety, achieving excellent results.
REFERENCES
1. Mareth K, Gurm H, Madhoun MF. Endoscopic recognition and
classification of colorectal polyps. Gastrointest Endosc Clin N Am.
2022;32(2):227-40.
2. Shaukat A, Kaltenbach T, Dominitz JA, Robertson DJ, Anderson
JC, Cruise M, et al. Endoscopic recognition and management strat-
egies for malignant colorectal polyps: Recommendations of the US
multi-society task force on colorectal cancer. Gastroenterology.
2020;159(5):1916-34.e2.
3. Von Renteln D, Bouin M, Barkun AN. Current standards and new
developments of colorectal polyp management and resection tech-
niques. Expert Rev Gastroenterol Hepatol. 2017;11(9):835-42.
4. Athanasiou CD, Robinson J, Yiasemidou M, Lockwood S,
Markides GA. Laparoscopic vs open approach for transverse colon
cancer. A systematic review and meta-analysis of short and long
term outcomes. Int J Surg. 2017;41:78-85.
5. Liu X, Wu X, Zhu R, Yu W, Zhou B. Comparison of survival
outcomes between laparoscopic and open colectomy for transverse
colon cancer: a systematic review and meta-analysis. Int J Colorec-
tal Dis. 2023;38(1):111.
VIDEO: https://youtu.be/gEr33Ilog4o
The authors declare no conflict of interest. Alejandro Barbosa Martínez: alejandrobarbozamartinez@gmail.com
Received: December 27, 2023. Accepted: March 5, 2024
Barboza A. ORCID:0009-0001-8828-3628; Brito N. ORCID:0000-0002-1394-3994; Domínguez F. ORCID:0000-0002-1746-7091; Durán F. ORCID:0000-0002-0426-3284;
Laurini M. 0000-0003-2494-1756; Viola M. ORCID:0000-0003-2733-5276
