Hospital Universitari Son Espases, Palma, Mallorca, Spain.
Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain.
Surg Endosc. 2020 Jun;34(6):2763-2772. doi: 10.1007/s00464-020-07423-9. Epub 2020 Feb 21.
The aim of this study was to describe all the possible approaches for laparoscopic splenic flexure mobilization (SFM), each suitable for specific situations, and create an illustrated system to show SFM approaches in an easy and practical way to make it easy to learn and teach.
Two different phases. First part: Cadaver-based study of the colonic splenic flexure anatomy. In order to demonstrate the different approaches, a balloon was placed through the colonic hepatic flexure in the lesser sac without sectioning any of the fixing ligaments of the splenic flexure. Second part: A real case series of laparoscopic SFM.
First part: 11 cadavers were dissected. Five potential approaches to SFM were found: anterior, trans-omentum, lateral, medial infra-mesocolic, and medial trans-mesocolic. The illustrative system developed was named: Splenic Flexure "Box"(SFBox). Second part: One of the types of SFM described in first part was used in five patients with colorectal cancer. Each laparoscopic approach to the splenic flexure was illustrated in a video accompanied by illustration aids delineating the access.
With the cadaver dissection and subsequent demonstration in real-life laparoscopic surgery, we have shown five types of laparoscopic splenic flexure mobilization. The Splenic Flexure "Box" is a useful way to learn and teach this surgical maneuver.
本研究旨在描述腹腔镜脾曲游离（SFM）的所有可能方法，每种方法都适用于特定情况，并创建一个图示系统，以简单实用的方式展示 SFM 方法，使其易于学习和教学。
分两个不同阶段。第一部分：基于尸体的结肠脾曲解剖学研究。为了演示不同的方法，将一个气球通过结肠肝曲放置在小网膜腔中，而不切断脾曲的任何固定韧带。第二部分：腹腔镜 SFM 的真实病例系列。
第一部分：11 具尸体被解剖。发现了 5 种潜在的 SFM 方法：前侧、网膜间、外侧、内侧下结肠系膜和内侧结肠系膜间。开发的图示系统命名为：脾曲“盒”（SFBox）。第二部分：在 5 例结直肠癌患者中使用了第一部分描述的 SFM 类型之一。每个腹腔镜脾曲入路都在一个视频中进行了说明，并附有插图辅助，勾勒出了进入路径。
通过尸体解剖和随后在实际腹腔镜手术中的演示，我们展示了 5 种腹腔镜脾曲游离术。脾曲“盒”是学习和教授这种手术操作的一种有用方法。
