With more than 14 years in the service of Medicine, the Specialist in General Surgery and Digestive System Surgery, Marta Jimenez Toscano, has focused her career on the study of Gastrointestinal Surgery, fulfilling her management from the diagnosis and treatment of benign and malignant tumors. Her extensive knowledge and development of praxis has positioned her as one of the most important surgeons in the field of Digestive System, performing her management in several hospitals and clinics in the country. Surgeon in the Colorectal Unit at the Parque de Salud Mar, Hospital del Mar. Barcelona Assistant Physician in the Gastrointestinal Surgery Unit at the Hospital Clínic de Barcelona. Surgeon in the Gastrointestinal Surgery Unit at Hospital Universitario Quirónsalud. Resident Doctor in the General and Digestive Surgery Unit at the Hospital Universitario Fundación Alcorcón. Degree in Medicine and Surgery from the Universidad Autónoma de Madrid.
Selected publications from PubMed
Analysis of the national situation of right hemicolectomy with complete mesocolic excision in ascending and proximal traverse colon cancer.
Abad Camacho MR, Jiménez-Toscano M, García-Granero Á, Alonso-Gonçalves S, Salvans S, Tellez C, Montcusí Ventura B, Pascual Damieta M
Cir Esp (Engl Ed). 2026 Jun;104(6):800313 doi: 10.1016/j.cireng.2026.800313.
An Exosome-Based Liquid Biopsy for the Detection of Early-Onset Colorectal Cancer: The ENCODER Multicenter Study.
Mannucci A, Balaguer F, Yamada Y, Nagasaka T, Toiyama Y, Okugawa Y, Martí-Gallostra M, Jiménez-Toscano M, Vidal-Tocino R, Jiménez F, Perea J, Quintero E, Boland CR, Cavestro GM, Goel A, SECOC-ENCODER Collaborators
Gastroenterology. 2026 Feb;170(2):330-343 doi: 10.1053/j.gastro.2025.08.013.
Organ/space surgical site infection and long-term outcomes of rectal cancer surgery: retrospective population-based cohort study.
Matallana C, Manchon-Walsh P, Espín E, Pascual M, Biondo S, Jiménez-Toscano M, Borràs JM, Badia JM, Limón E, Aliste L, Font R, Pera M
BJS Open. 2025 May 7;9(3) doi: 10.1093/bjsopen/zraf052.
Telomere Length as a New Risk Marker of Early-Onset Colorectal Cancer.
Martel-Martel A, Corchete LA, Martí M, Vidal-Tocino R, Hurtado E, Álvaro E, Jiménez F, Jiménez-Toscano M, Balaguer F, Sanz G, López I, Hernández-Villafranca S, Ballestero A, Vivas A, Melone S, Pastor C, Brandáriz L, Gómez-Marcos MA, Cruz-Hernández JJ, Perea J, González-Sarmiento R
Int J Mol Sci. 2023 Feb 9;24(4) doi: 10.3390/ijms24043526.
Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.
REACCT Collaborative, Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Bebington B, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Boutall A, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Fleming F, Foppa C, Fowler G, Frasson M, Figueiredo N, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Gong J, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hoffmeister M, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, São Julião GP, Panaiotti L, Panis Y, Papamichael D, Park J, Patel S, Patrón Uriburu JC, Pera M, Perez RO, Petrov A, Pfeffer F, Phang PT, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Reyes Meneses JC, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Salido AJ, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shine R, Shlomina A, Sica GS, Singnomklao T, Siragusa L, Smart N, Solis A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Sunderland M, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Jiménez-Toscano M, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Winter DC
JAMA Surg. 2021 Sep 1;156(9):865-874 doi: 10.1001/jamasurg.2021.2380.
Ureteral damage is one of the intraoperative complications most feared by surgeons. The first thing that we must all have in mind is avoiding the section of such an important structure. There are two possibilities regarding prevention. Some surgeons prefer to perform a complete dissection of the inferior mesenteric vessels and the retrocolic space which allow them to look for the ureter before the vessel section and complete the procedure. On the other hand, there are surgeons who argue that if you are in the correct surgical plane, preserving correctly the retrooperitoneum, there is no need to look for the ureter before continuing the procedure. In our group we are in favor of the latter. Nevertheless there are some dificult situations such as obese patients, hostile abdomen with a lot of adherences, fatty mesocolon, dolicosigmas, etc. which increase the risk of ureteral lesions. But this unpleasant complication is not a synonymous with conversion to open surgery. In experienced hands, the laparoscopic approach, together with the use 3D view systems, provides a high definition view which makes it possible to diagnose complications, guide an ureteral catheter correctly and suture the ureter over it. In the next video we will show a ureteral section that took place during the abdominal access in a transabdominal-transanal total mesorrectal excision. We describe the main surgical steps to complete its correct repair. Case The clinical case is a 77-year-old woman with a BMI of 34 Kg/m2 and a diagnosis of middle rectum cancer cT3N0 treated with neoadjuvant chemoradiotherapy. Due to obesity and intrabdominal adherences, the definition of the surgical planes was especially difficult and a ureteral lesion occurred. Treatment The perianal approach performed during the TaTME allowed accurate pelvic dissection. The increased traction obtained by the two teams working at the same time better defines the surgical plane and improves the visualization of the surrounding organs. These advantages are especially important in both laterals and the anterolateral region to preserve the nerves, the vessels and the entrance of the ureter into the pelvis in the upper rectum. The anatomical landmarks from the pelvis should be known. After the resection the correct intact presacral plane could be visualized as well as the hypogastric vessels and nerves. Thanks to this close evaluation we were able to observe a lateral damage of the ureter with a partial section. In the video you can see the ureter, with its creeping movement, crossing over the division of the iliac artery. This unpleasant complication is not synonymous with conversion into open surgery. In experienced hands, the laparoscopic approach provides a high definition view which makes it possible to diagnose the complications, guide a ureteral catheter correctly and suture the ureter over it. The transanal approach combined with a 3D camera provided a direct view of the ureter, so we were able to make a first simple prolene stitch through the sectioned ureter. To check the correct lumen of the ureter we introduce an avocath, also transanally. You can introduce the catheter through the 10 mm trocar or taking out the silicon device, which is also easy and fast. The other surgeon on the abdominal side can help by performing gentle traction of the proximal side of the ureter. This way we can check that we have properly respected the lumen of the ureter before finishing the end to end anastomosis with 3 single stitches. Finally, a pig tail catheter is introduced by cystoscopy localizing the left ureteral lumen. Outcome The patient’s evolution was correct, and she was discharged 6 days after surgery. In conclusion, the ureteral injury is a feared intraoperative complication that can be solved laparoscopically. Its transanal repair is feasible and safe, providing a direct high definition view of the damage. The 3D view can add depth, helping us to perform such a demanding procedure.
Published
Jul 2016
When you have to chose who are the best patients to start performing the Cecil approach, everybody usually agrees in indicating the procedure for thin women with a middle rectal cancer. Nevertheless, older women have some specific characteristics that can make the procedure more difficult than expected, such as redundant colon, enterocele, lax tissues, etc. We can see how the combined approach will help us to increase the traction countertraction to solve the problems caused by laxity. Thanks to TaTME we were able define the anterior plan, which we would probably miss and follow too anteriorly using a conventional laparoscopic approach. After more than 200 cases, when people ask which kind of patient is the best to begin performing a trasanal total mesorrectal excision, we usually recommend a thin female with a middle rectal cancer. Thanks to their anatomical characteristics, women are the most appropriate patients as they have a wide pelvis, no prostate or seminal vesicles bordering on the anterior side, and provide the opportunity to mobilize the vagina for better definition of the surgical planes. But is a female pelvis always easiest? There are some characteristics, especially in older women, that can make this procedure challenging in this group of patients. In this video, we will try to show which difficulties you could find in a female pelvis. We present an 83-year-old woman with high blood pressure, dyslipidemia and Barrett’s esophagus. Due to rectal bleeding, the patient was diagnosed with rectal cancer 7 cm from the anal verge. Baseline staging revealed an mriT3N1 lesion plus resectable lung metastases by CT-Scan. This older lady received chemoradiotherapy with moderate response to a mriT2N0. Finally a low anterior resection with TME transanally and transabdominally was performed (Cecil approach). The patient was placed in a lithotomy position. Four trocars were used transabdominally, a 12 mm trocar was placed umbilically for the camera, and three 5 mm trocars were also placed, two in the right iliac fossa and one in the left hemiabdomen. A gel cap platform was used for the transanal approach. A wide pelvis, typical of a female patient, is visualized. Then the mesosigmoid peritoneum is incised to define the correct posterior plane. The inferior mesenteric artery is individualized. A high ligation of the artery was accomplihed by using the Ligasure™ after placing some proximal clips. The epiploic adhesions and Toldt’s fascia , which adhere the descending colon to the lateral abdominal wall, are resected, as well as the possible adhesions to the spleen. Simultaneously the transanal approach is performed. Firstly, after visualizing the rectal tumor, a pursestring suture is made with PDS or prolene to close the rectal lumen. After the rectum is closed a tattoo is made with the electrocautery. The down to up dissection is begun in a circumferential manner. We usually begin on the anterior side, where you can see some fibrosis secondary to the preoperative treatment. We continue afterwards on the posterior side preserving the mesorectum. And on the lateral side connecting the anterior and posterior dissections. At the same time, the abdominal dissection is continued into the pelvic space to perform a total mesorrectal excision. The left lateral side is also incised taking care not to damage the vessel and nerves. We continue our dissection through the presacral space preserving the mesorrectal fat. We can now see a deep Douglas down in the pelvis so we continue our dissection on the left lateral side, keeping the anterior side closed until the connection with the transanal team is made. This deep Douglas makes it difficult for us to maintain a correct traction countertraction so we require significant traction to proceed with the dissection and define the surgical plane. As you can see, the laxity of the tissues in older patients can complicate the procedure, making dissection more difficult. This patient has also a redundant sigmoid colon, which leads us to change the position of the instruments to maintain traction. Patient characteristics such as tissue laxity and medical situations such as enterocele can pose a real problem when finding the rectovaginal space. Thanks to the help of neumorectum and the work of the transanal team, we can find the correct anterior plane to incise the peritoneum more easily: not too close to the rectum where we could damage it or too close to the uterus or vagina, where we could find a bleeding plane. As you can see, the abdominal team is just increasing traction, pulling away the rectum from the vagina, in order to help the transanal team find the correct surgical plane. Coming back to the transanal approach, we will now focus on the anterior side, where the abdominal team is having problems defining the plane due to the laxity of the patient’s tissues. Thanks to the traction performed by the abdominal team, we can visualize the light and the correct plane through the anus. The rendezvous between both teams is achieved, thanks to the combined work. The correct plane is probably closer to the rectum than we had previously thought. Without the combined approach, we would probably have missed the anterior plane and done it too anteriorly. Once the correct plane is achieved, we can continue the abdominal dissection applying the right traction. With these lax tissues, traction for both teams is essential to perform lateral dissection with no injuries. The abdominal team retract from the distal side of the rectum to increase posterior traction, in order to complete the dissection transanally. In this way, the transanal team can perfectly see the correct posterior plane to finish the rectal resection and the specimen is introduced in the abdominal cavity. A prolene purse string on the distal rectum is made to perform the mechanical anastomosis. A silicon tube is connected to the spike of the stapler to exteriorize it through the anus more easily. The pelvis is now more narrow than we had thought at the beginning of the procedure, and the big uterus with an anterior myoma makes it even more difficult. Transanally, a clinch is introduced through the anus under laparoscopic supervision to exteriorize the proximal colon and the spike of the stapler to finish the anastomosis. The correct proximal colon position is checked. The colorrectal anastomosis is checked for leakage or bleeding and solved as soon as possible.
Published
Mar 2016
Case A 47-year-old male with a history of morbid obesity and a BMI of 37.7Kg/m2 (Height 1.70 meters, weight 109 Kg). He is a multipathological patient as he suffered from: High blood pressure (treated with 3 drugs), type two diabetes mellitus (treated with 26 insulin units per day plus metformin) HbA1c 7,8, dyslipidemia, positive for HCV, asthma, BPD Gold B and severe OSA that required CPAP, also chronic kidney failure due to microscopic polyarteritis that required a kidney transplantation and correct graft function. He underwent an exploratory laparotomy three years ago at another hospital due to a suspected intestinal ischemia. No bowel was resected at that time but as a complication he had a large incisional hernia. At the preoperative study the upper gastroscopy was normal, no hiatal hernia was found, and the biopsy was negative for helicobacter pylori. The abdominal ultrasound was compatible with liver steatosis. ASA score III. Treatment The patient was placed in the supine position with legs wide open. The leading surgeon stood between the patient's legs with one assistant on each side. A total of 6 ports were used: the first one was a 12mm port located at the right flank. Then a 12 mm periumbilical port was placed to the right of the incisional hernia. Two 5mm ports were located in a subxiphoid position; a very lateral port was placed at the left flank; a 12mm port was located at the left flank; and the last port was placed at the epigastrium. After the placement of the first trocar the camera was introduced to explore the abdominal cavity. Notice that there was a large amount of small bowel attached to the anterior abdominal wall. A portion of the major omentum was also attached and pulling up the transverse colon. A 12mm port was introduced under direct laparoscopic supervision very low in the right flank. The camera was changed in that port which made it possible to introduce the scissors at a nice angle to perform adhesiolysis in order to clear the surgical field and place the rest of the ports. We use the LigaSure™ when we are sure that the gut is at a distance. This enables faster dissection and improves hemostasis control. Here we are taking down the major omentum. Soon the surgical field will be free to perform the sleeve gastrectomy. Then we continued with the standard procedure, opening a window with the hook at the gastrocolic ligament to access the lesser sac. The LigaSure™ is used to complete this mobilization as it seals the tissue and sections it. The assistant surgeon helps by pulling the gastrocolic ligament, thus improving the exposure and ensuring visualization of the limit of the major curvature. We always verify the limits of the dissection. It is crucial to identify the pylorus and make sure that the major curvature is released at least 5 cm from it. The adhesions on the posterior wall should be removed to allow correct traction of the stomach during the placement of the mechanical sutures. This maneuver should be performed across all the stomach that will be involved in the gastrectomy. Sharp dissection using the hook is recommended, taking care to preserve the short vessels in the lesser curvature. Now we are moving towards the fundus. Once again, the transaction between the leading and the assistant surgeon achieves the exposure by opening the surgical field like a book. A nice maneuver to fully dissect the fundus involves the assistant surgeons grabbing the stomach and performing traction with the clinch. This allows the leading surgeon to perform extra traction of the stomach with his left hand while dissecting with the Ligasure™ . We mobilize until the left crus is identified. Then the anesthesiologist introduces a 35 Fr bougie to calibrate the gastrectomy. We assist with the placement of the bougie. The gastrectomy begins. We use mechanical sutures. As a precaution we count 20 seconds before firing it. This improves hemostasis. The combination of stomach traction and articulation of the mechanical suture provides the correct angle to build an untwisted and symmetrical gastrectomy, which ensures good outcomes for patients. In the last firing we make sure that we are 1 cm away from the angle of His and that the mechanical suture involves all the gastric tissue. This prevention maneuver prevents leaks. We don't make a prolene running suture, but only make knots from the gastroepiploic ligament to the stapler line to avoid twisting and reinforcing bleeding zones if required. We always check for bleeding from the stapler line, placement of clips may solve this issue. Outcome The surgery was uneventful and took 105 minutes. No drainage was left. The patient started oral intake and left hospital on the second postoperative day with no complications. One month after the procedure he has lost 10Kg. There is no reflux or abdominal pain, and no insulin is required.
Published
Mar 2016
In this video we will present some surgical scenarios showing the most common problems related with the pneumorectum that can arise when performing the Transanal TME. Transanal access platform set up: The first issue that may be found is that it is impossible to introduce the transanal access platform. This can happen because of a narrow or long anal canal, a hypertonic sphincter, or lack of relaxation. The use of a Lone Star retractor to expose the anus, good lubrication of the device and the use of dilators could decrease the situation. In addition, close interaction with the anesthesiologists is necessary, as this technique requires intense neuromuscular blockage to diminish sphincter pressure. Undesired effects of the pneumorrectum: Once the procedure has begun, we should take into account the effect of the transanal pneumorectum on the abdominal field. A retropneumoperitoneum can be generated, impairing the transabdominal team’s work. We strongly recommend that both teams work simultaneously (the Cecil approach). If only one team is available, the abdominal field should be performed prior to using the pneumorectum through the anus. The transanal pneumorectum can also insufflate the proximal colon, making the sigmoid resection difficult. To avoid this, the surgeon on the abdomen should clamp the distal sigmoid colon until the purse string is closed. If clamping the colon is not possible or has failed, the solution is deflating it using a rectal tube. Lack of rectal distention: Another common problem is the lack of correct distension of the rectal lumen when a pursestring has to be created or even during the dissection. The reason could be again incorrect neuromuscular blockage to avoid the effect of the surgical stimulus on the rectal wall and pelvic floor muscles. Another reason is high pressure from the abdomen. Try to reduce the CO2 on the abdomen by increasing pneumorectum pressure, until both sides are connected and pressure is equal again. Pursestring issues: Proper closure of the pursestring is essential to build a sealed cavity and achieve the exposure to work properly. A mistake during this step can create CO2 leakage in the rectal lumen giving rise to contamination and tumor spillage. Moreover, the proximal lumen will be insufflated which will hinder performance of the sigmoidectomy. To perform this step correctly we recommend making a tight knot, without the transanal access platform cap, ensuring a sealed cavity. If the error persists you should make a new suture or another stitch before moving on to the next step. Take care not to cut the suture due to too close rectal transection. Smoke evacuation: Another important issue to be concerned with is the kind of the device we use to provide the CO2 and evacuate the smoke. The conventional insufflator works in a pulsating manner, which increases rectum movement. In addition, every time we open a valve to evacuate the smoke, this modifies intraluminal pressure, resulting in significant pumping of the rectal tissue. All these factors hinder the procedure and tire out the surgeon so the procedure takes longer and the quality of the dissection may be compromised. Another type of insufflation device works by maintaining constant pressure on the pelvic cavity with a permanent smoke evacuation. Thanks to this device you can achieve a stable working field with a clear view. Which problems do you recognize on the next video? Exactly, we had problems with rectum distension as well as with smoke. What did we do? We achieved correct patient relaxation, low pressure in the abdominal cavity, and introduced CO2 insufflators that were able to maintain constant lumen cavity pressure. To sum up, with these easy tips and tricks you can solve some frequent problems that surgeons can find during the TaTME procedure.
Published
Feb 2016
Case An 82-year-old female patient, with a medical history of high blood pressure and an oncological left mastectomy, was evaluated due to a recent dysphagia and diagnosed with a tumor in the esophagogastric junction. A 7 cm mass on the gastric fundus was found in the water-soluble study. The gastroscopy confirmed a 7 cm neoplasm with a short and wide pedicle and a pathological study was performed to confirm that it was a gastrointestinal stromal tumor. To complete the study, a CT scan was performed, which confirmed that the tumor had no distal metastasis. Treatment Due to the location of the tumoral mass and the characteristics of the patient, we decided to initiate Gleevec to reduce the tumoral mass, with a final size of 2.7 cm in the CT scan. After this good response to medical treatment, surgery was performed. The patient was placed, under general anesthesia, in the supine position with open legs, in the Anti-Trendelenburg position. A twelve mm trocar was introduced supraumbilically for the camera and four 5 mm trocars were placed, two on the left side of the abdomen, one on the right side, and one in the subxiphoid region. Firstly, a laparoscopy was performed and the greater and lower curvature and the angle of His were released from the surrounding tissue. Under endoscopic control, a 3 cm tumor was localized in the esophagogastric junction. The endoscopic transillumination and the laparoscopic external pressure help to localize the tumor and evaluate the integrity of the viscera after the procedure. The neoplasm was resected by means of loop diathermy under intraabdominal visual control, and the specimen was extracted endoscopically with an endobag. A small hemorrhage was solved using endoscopic clips. The integrity of the gastric wall was evaluated using methylene blue. Finally, a sero serosal-suture was made to protect the resected area and an anterior gastric flap was created. Blake drainage was placed in the abdominal cavity. Outcome On the second postoperative day a water-soluble study was performed to check the absence of leakage and the patient was put on an oral diet. The patient had an uneventful evolution with no short-term complications. The pathological result described a gastrointestinal stromal tumor with 1/50 mitosis and G1 low grade differentiation, T2 stage. The patient had no recurrence after three months of follow up.
Published
Aug 2015
This video is focused in the main steps to perform a right colectomy by minimal invasive surgery. The patient was placed in supine position, the leading surgeon standing on the left plus two assistant surgeons, one on each side of the patient. A total of five trocars were used: a 12-mm trocar to the left of the umbilicus for a 30° scope, another 12-mm trocar at the epigastrium, and a 5-mm trocar at the hypogastrium. These were the working channels for the leading surgeon. Two extra 5-mm trocars were placed at the right iliac fossa and the right flank as working channels for the assistant surgeon. The first maneuver is to accommodate the mesocolon. The patient was moved into a reverse Trendelemburg position and slightly to his left. Performing traction at the cecum helps to identify the right ileocolic vessels. The assistance surgeon must maintain the traction of the vessels and the transverse colon. Vascular dissection begins by opening a window at the peritoneum using the hook. There are several ways to perform vascular ligation; the most delicate one is to identify the artery and the vein prior to the section. >A dissector is necessary to individualize the vessels from the surrounding fatty tissue. As can be seen two clips are placed at the origin of the artery and a distal is placed to ensure hemostatic control. The vein can be sectioned with the LigaSure™. Other option is to fire a vascular mechanical suture, making sure that the duodenum is respected. Ligation of the right colic artery and the right branch of the medial colic artery must be included in cases of colonic adenocarcinoma. The assistant surgeon then performed traction from the vessels stump exposing the retroperitoneal plane. Medial to lateral mobilization is carried out as far as possible which facilitates the lateral detachment of the colon. The hook makes sharp dissection possible, and laparoscopic DeBakeys are used to improve traction and exposure. This plane can be fused in patients with previous renal surgery. The landmark is the hepatic flexure; the duodenum should always be borne in mind to prevent unexpected injuries. A piece of gauze is placed below of the colon at the end of the medial mobilization. At this stage, the assistant surgeon performed a cranial traction from the gallbladder and pulled the colon towards the pelvis. The gauze was identified and revealed the correct plane for lateral dissection. Once again the hook was used to open a window at the peritoneum, enabling the LigaSure to perform the rest of the job by detaching the ascending colon. It is important to mobilize until the duodenum is visualised, in order to enable correct exteriorization of the specimen. The appendix can be used to change the exposure of the cecum and complete its dissection with the energy devices. The mesentery of the terminal ileum is also sectioned to release tension and avoid bleeding during the exteriorization of the specimen The assistance incision is performed by enlarging the right-flank trocar wound. It is about 5 cm long, depending on the size of the colon, the lesion, and the mesentery. A bag is placed to protect the wound and the specimen is pulled out. After checking that margins are correct the mesocolon is prepared. Section of the colon and terminal ileum is performed with mechanical sutures. Making a knot at the stapler line to perform traction during the anastomosis is recommended. A enterotomy and a colotomy was made to introduce the mechanical suture and create the anastomotic lumen. One surgeon makes a knot at the medial aspect of the anastomosis to release tension while other surgeon checks for for bleeding of the stapler line. A last mechanical firing seals the anastomosis.
Published
Apr 2015
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