![]() Sometimes it is simply considered a symptom of conditions like irritable bowel syndrome (IBS) alongside bloating and excessive flatulence. However, splenic flexure syndrome is not always recognized as a separate clinical entity. Mobilization of the splenic flexure is achieved by incising the lateral peritoneal attachments along the descending colon and mobilizing the colon out of. This technical report describes all the major aspects for successful performance of this complex minimally invasive procedure. Splenic flexure syndrome tends to be more common and is possibly due to the sharp bend in this part of the colon. The authors developed a new "one-step" setup to perform a low anterior resection with total mesorectal excision and splenic flexure mobilization for rectal cancer using a completely robotic approach. Once the middle colic artery is divided, the splenic flexure becomes entirely reliant on blood supply from the inferior mesenteric artery (IMA). ![]() It is not advisable to make an anastomosis in the region of the splenic flexure, because this region is a watershed zone. The new da Vinci S HD system offers improved range of motion that allows for easier access to a wider surgical field. The key point is takedown and resection of the splenic flexure. However, difficulties accessing multiple quadrants of the abdomen with the first robotic system led to a rather slow introduction of the da Vinci into the field of abdominal surgery compared with its success with urologic and cardiac procedures. Some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of the robotic da Vinci system, and its use in gastrointestinal procedures is evolving. hemostasis is simplified, clumsy stumps are avoided and if mobilization of the hepatic and splenic flexures is necessary such is easily accomplished. Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization. This article describes the technique of a robotic low anterior resection, including splenic flexure mobilization, total mesorectal excision and specimen extraction, and well the peri-operative management.
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