The aim of the study to compare surgical outcomes between inferior mesenteric artery first with complete medial approach and other traditional techniques in laparoscopic left sided colorectal cancer .
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Those younger than 18 years or older than 70 years.
Those undergoing non-cancer resections, or completion surgery or palliative procedures.
Those with locally advanced ( extra colonic extension ) or metastatic tumors.
Those with advanced comorbidities ( laparoscopy is contraindicated )
Parallel
laparscopic splenic flexure mobilization
Procedure/SurgeryThe patient was positioned in the modified lithotomy position with the main surgeon standing in between the abducted legs. The patient's head is lowered by 15° (Trendelenburg position), and table was 20° right-tilted. The position was adjusted at the time of splenic flexure mobilization to head elevation by 20° to let the small bowel go down toward the pelvis. Five ports were introduced \[Figure 1\]: a 10-mm port in the midline 4 cm above the umbilicus to increase the field of view, a second 5 mm port in the right midclavicular line just below the umbilicus, a third 10-12-mm port at the right midclavicular line in the right iliac fossa, a fourth 5-mm port in the left midclavicular line 2 cm above the level of the umbilicus, and a last 5-mm port in the midline 4 cm above the pubic bone. Port sites for laparoscopic left colectomy. The tumor was localized by either visual inspection or intraoperative colonoscopy. The summit of sigmoid colon was then pulled anteriorly with a grasper toward
evaluation of safety and effectiveness of inferior mesenteric artery first in combination with complete medial approach in splenic mobilization in left sided colorectal cancer .
number of harvested lymph nodes
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