Associated vessel heteromorphosis in laparoscopic complete mesocolic excision and solutions to intraoperative hemorrhage.
- Author:
Yurong JIAO
1
;
Jinjie HE
;
Jun LI
;
Dong XU
;
Kefeng DING
2
Author Information
1. Department of Surgical Oncology, Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China. jiaoyurong@zju.edu.cn.
2. Department of Surgical Oncology, Second Affiliate Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China. dingkefeng@zju.edu.cn.
- Publication Type:Journal Article
- MeSH:
Colonic Neoplasms;
surgery;
Dissection;
Hemorrhage;
prevention & control;
Humans;
Laparoscopy;
Mesenteric Artery, Inferior;
Mesenteric Veins;
Mesocolon;
surgery
- From:
Chinese Journal of Gastrointestinal Surgery
2018;21(3):259-266
- CountryChina
- Language:Chinese
-
Abstract:
Vessel identification and dissection are the key processes of laparoscopic complete mesocolic excision (CME). Vascular injury will lead to complications such as prolonged operative time, intraoperative hemorrhage and ischemia of anastomotic stoma. Superior mesenteric artery (SMA), superior mesenteric vein(SMV), gastrointestinal trunk, left colic artery(LCA), sigmoid artery and marginal vessels in the mesentery have been found with possibility of heteromorphosis, which requires better operative techniques. Surgeons should recognize those vessel heteromorphosis carefully during operations and adjust strategies to avoid intraoperative hemorrhage. Preoperative abdominal computed tomography angiography(CTA) with three-dimensional reconstruction can find vessel heteromorphosis within surgical area before operation. Adequate dissection of veins instead of violent separation will decrease intraoperative bleeding and be helpful for dealing with the potential hemorrhage. When intraoperative hemorrhage occurs, surgeons need to control the bleeding by simple compression or vascular clips depending on the different situations. When the bleeding can not be stopped by laparoscopic operation, surgeons should turn to open surgery without hesitation.
