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Laparoscopic Left Colectomy

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Colorectal cancer, the 3rd most common cancer worldwide, is generally treated with surgical resection. The data for the laparoscopic approach to colon resection has revealed several advantages over the open technique including shorter hospital stay, reduced length of postoperative ileus, earlier resumption of oral nutritional intake, reduced surgical pain, and improved cosmesis. Furthermore, there is no difference in oncologic outcomes between open and laparoscopic colectomy. These advantages have led to an increasing use of the laparoscopic technique for colon resection. In this chapter, we discuss the key operative steps necessary to a successful laparoscopic left colectomy, highlighting anatomical and preoperative considerations, key factors of the operative technique, and postoperative management and its complications.


  • Laparoscopic hemicolectomy
  • Minimally invasive colectomy
  • Colon cancer
  • Inferior mesenteric vein
  • Inferior mesenteric artery

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Correspondence to Julio Garcia-Aguilar M.D., Ph.D. .

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In this video, the surgeon demonstrates his approach to laparoscopic left colectomy. (WMV 45614 kb)

Key Operative Steps

  1. 1.

    Place the patient in modified lithotomy position.

  2. 2.

    Create pneumoperitoneum using a Veress needle.

  3. 3.

    Use medial-to-lateral dissection approach.

  4. 4.

    Identify, isolate, and divide the inferior mesenteric vein.

  5. 5.

    Identify, isolate, and divide the inferior mesenteric artery after identifying and preserving the left ureter.

  6. 6.

    Dissect the mesocolon from the retroperitoneal structures.

  7. 7.

    Mobilize the descending and sigmoid colon from the lateral abdominal wall. Mobilize the greater omentum and splenic flexure

  8. 8.

    Transect the rectosigmoid colon.

  9. 9.

    Use a Pfannenstiel or periumbilical incision for specimen extraction using a wound protector.

  10. 10.

    Perform extracorporeal placement of an anvil after proximal division of the left colon.

  11. 11.

    Perform laparoscopic intracorporeal end-to-end anastomosis using a circular stapler.

  12. 12.

    Perform an air leak test.

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Samdani, T., Garcia-Aguilar, J. (2015). Laparoscopic Left Colectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY.

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