Video Abstracts

Abstract

16 | Three-\xaddimensional\xadcomputed\xadtomography\xaddeveloped\xad vascular\xadanatomy\xadfor\xadright\xadhemicolectomy J. George1,2, P. Metherall1, R. deNoronha1 & K. Chapple1 1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom, 2University of Sheffield, Sheffield, United Kingdom Background: A thorough understanding of the highly variable vascular anatomy around the mesocolic root is essential for more advanced rightsided colon cancer surgery, such as complete mesocolic excision. Conventional monotone CT scans are difficult to interpret in this respect. We describe a technique whereby contrastenhanced crosssectional computed tomography (CT) images are developed into a simplified, easilyviewable threedimensional (3D) model, providing a surgicallyintuitive display of right colonic arterial and venous anatomy. Methods: Patients with rightsided colonic cancer undergoing elective complete mesocolic excision underwent a biphasic contrast CT protocol to simultaneously acquire arterial and venous phases. Images of the arterial and venous abdominal vasculature were segmented using regiongrowing algorithms, automatic deformable contouring and manual delineation. Separate segmentations were drawn for the colon and the abdominal vasculature. Contours were converted into a triangulated surface mesh and each mesh smoothed to achieve acceptable 3D structural visualisation before combination as an interactive 3D portable document format (PDF) file. Results: 3D vascular visualisations were created for all patients (n = 5). Vascular anatomy was able to be easily viewed preoperatively using the Adobe Acrobat viewer in an anatomicallyand surgicallyrelevant format. Files were prepared with minimal radiological time and at a cost acceptable within current NHS funding restraints. Conclusions: Preoperative 3D imaging of colonic vascular anatomy is feasible and demonstrates vascular anatomy in a format easily accessible and understandable to the surgeon, with acceptable preparatory timeand costlimitations. 18 | Natural\xadorifice\xadsurgery\xadcan\xadbe\xadless\xadcontroversial\xadin\xadselected\xad cases! M. Abdeldayem, H. Bakr & A. Wagstaff Prince Charles Hospital, Merthyr Tydfil, United Kingdom Introduction: Main criticism of natural orifice surgery is adding extra layer of risk to minimally invasive surgery. In selected cases added risk is minimised when the natural orifice is used as a part of a combined procedure. Aim: To demonstrate a case of laparoscopic anterior resection of the rectum combined with laparoscopic assisted vaginal hysterectomy. The specimen is delivered, and the bowel is prepared for anastomosis transvaginally. Method: A case of early rectosigmoid tumour with endometrial lesion shown in staging CT scan. The decision of the Colorectal and Gynaecology MDTs to proceed for a combined approach. The following approach was used: Medial to lateral mobilisation of the rectosigmoid mesentery followed by control of the Inferior Mesenteric Artery. Identification and protection of the left ureter. Lateral mobilisation of the sigmoid colon and rectum. The upper rectum and sigmoiddescending junction were divided using endostapler and specimen secured in an endobag. Full mobilisation of splenic flexure and division of the IMV at the lower border of the pancreas to ensure tension free anastomosis. Laparoscopic assisted vaginal Hysterectomy was performed. Resected bowel and uterus were delivered through the vagina. The bowel was prepared through the vagina for the anastomosis and returned back into the peritoneal cavity followed by closure of the vaginal vault. Stapled colorectal anastomosis was performed. Results: Patient had a smooth postoperative recovery, Enhanced Recovery Protocol and discharged 3rd postoperative day. Conclusion: We recommend natural orifice surgery in selected cases as long as the extrarisk is minimised. The procedure is oncologically safe and the anastomosis is tension free. 19 | Splenic\xadFlexure\xadMobilisation,\xadHow\xadto\xaddo\xadit\xadand\xadhow\xadnot\xadto\xad do\xadit? M. Abdeldayem, H. Bakr, A. Wagstaff & A. Masoud Prince Charles Hospital, Merthyr Tydfil, United Kingdom Introduction: Splenic Flexure Mobilisation can be challenging. It can be done either to gain extra length for a tension free anastomosis or as a part of colonic resection. Identifying the right dissection plane and the vital structures around the flexure are the keys for safe mobilisation. Aim: To demonstrate a streamlined approach to a safe laparoscopic mobilisation of the splenic flexure compared to dissection in the wrong plane. Method: The patient is positioned with head and left shoulder up. 1. Duodenojejunal flexure mobilisation. 2. Dissection and control of the Inferior Mesenteric Vein. © 2021 The Authors Colorectal Disease © 2021 The Association of Coloproctology of Great Britain and Ireland