Surgical Steps - Surgical Overview

The procedure is performed in a medial to lateral approach [above] as it:

• Provides a more "natural" view of the anatomy.
• Helps to avoid ureteral injuries through optimal representation of the sympathetic nerve plexus trunks, the left ureter, and gonadal vessels.
• Preserves the lateral abdominal wall attachments of the colon for a longer time during the dissection which increases workspace and exposure.
• Permits a safe primary dissection by avoiding unnecessary manipulation of the colon.
• Enhances complete lymphadenectomy following the vascular anatomy.

An overview on which part of the anatomy is mobilized (grey) and to what extent the colon/rectum is removed (green) during the procedure:

1. Initial Exposure
2. Primary Vascular Control
3. Medial to Lateral Mobilization of Sigmoid & Descending Colon
4. Splenic Flexure Mobilization
5. Rectal Dissection & Division
• Posterior Dissection
• Lateral Dissection
• Anterior Dissection
• Rectal Division