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356 Index
pararectal peritoneal reections,
253–254
Told’s fascia, 252–253
VHP, 251, 254
clinical trial, 275
coloanal anastomosis, 273
laparoscopic/robotic technique
anterior peritoneal reection, 258,
261–262
left m socolon mobilization,
255–256
left m sofascial separation,
255–256, 258–259
mesosigmoidal mobilization,
255–256
pararectal peritoneal reection
division, 255, 257
posterior mesofascial separation,
257, 2 6 0
right zone of adhesion, 257, 260
Waldeyer’s fascia identication,
259, 261, 263
mesosigmoidectomy
anterior peritoneal reection, 272
fascia overlying anterior
mesorectum, 273
IMA skeletonization and division,
268–270
mesosigmoidal mobilization,
266–268
mobilization of junction between
descending and sigmoid colon,
264, 266
pararectal peritoneal reection,
270–272
posterior mesorectal mesofascial
plane, 270
obesity in narrow male pelvis, 273
open total/partial mesorectal
excision, 264
TME/PTME, 254–255
UL exoscope, 264
RenderMan, 137
Reoperative abdominal surgery
adhesional complexes, 333
adhesions composition and
appearance, 337
avoiding mesenteric trauma, 337
challenge wit h, 333
controlling blood loss during damage,
337–338
diathermy dissection of abdomen,
333–335
diffe entiating mesentery, 334, 336
dissection in wrong plane, 340–341
incidence of variations, 338
laparotomy, 333, 335
minimizing contamination,
336–337
neoperitonealization, 333–334, 336
omental adhesions to small bowel,338
and postoperative complications,
338,340
soft adhesions between small intestine
loops, 333–334
technical diculty, 338–339
T4 intestinal cancer, 334
traction/countertraction and sharp
div ision, 334, 336
water injection technique, 333
Retroperitoneum, 44, 47–48, 252, 264,
266, 268, 278–282, 285–287,
317, 333
Reverse engineering mesentery
between duodenojejunal and splenic
exure, 44
left m socolon, 44
mesorectum, 44
mesosigmoid, 44
peritoneal reection
regresses,43–44
Right colectomy
anatomy, 277–278
circumferential mobilization, 291
in Crohn’s disease, 290
laparoscopic right mesocolectomy
lateral-to-medial mesenteric
detachment, 287–290
medial-to-lateral mesenteric
detachment, 285–287
mobilization, 284–285
open right mesocolectomy
colofascial separation, 278
congenital adhesions and right
peritoneal reection, 278–279
cutting/stapling techniques, 279,284
hepatocolic peritoneal reection,
279, 283
inferolateral peritoneal reection
division, 278–279, 281
mesofacial separation, 278–279
omento-colic peritoneal reection,
279, 284
right-sided intestinal lesions, removal
of, 291
Right congenital adhesions, 128
Right hemicolectomy, 277
Right mesocolectomy (RMC), 131, 277
Right peritoneal reection, 28
Robotic
colorectal surgery, 7, 139, 142–143
and laparoscopic mobilization
greater omentum, 301–302
mesosigmoidal, 348–349
splenic exure, 302, 349
transverse mesocolon, 303, 350
mesoigmoidal, 348–349
right mesocolectomy, 347–348
surgery (see Laparoscopic/robotic
surgery)
total mesocolectomy, 229
Robotic right mesocolectomy, 347–348
Root of mesenteric, 4, 120
S
Sclerosing mesenteritis, 97
Secondary mesenteropathy, 97
adenitis, 98–99
appendicitis, 98
castleman’s disease, 101
desmoid tumor, 95–96
lymphoma, 99
mesenteric cavitation syndrome, 101
metastatic disease, 86
peritoneal carcinomatosis, 99–100
phlegmon, 98
Sigmoid colectomy
correct plane for mobilization, 249
laparoscopic partial/total
mesosigmoidectomy
avascular interpedicular region,
236–237
Babcocks clamp placement, 238
blunt-tipped curved retractor
insertion, 237
colofascial separation, 239
fully skeletonized IMA, 236–237
linear staplers insertion,
237–238
medial to lateral mesosigmoid
mobilization, 234, 236
mesofacial separation, 238
mesosigmoid peritoneal reection,
234–235
peritonotomy, 234–235
open mesosigmoidectomy, 239–249
operative eld preparation, 234
preoperative preparation, 233–234
randomized control trial, 249
Sigmoidectomy, 233
Small and large intestinal mesentery,
3,7–8
Small bowel mesentery, 121
Small bowel peritoneal reection, 125, 128
Small bowel resection
backlighting , 311, 313
bleeding and hematoma limitation, 312
Index 357
digital model
mesenteric root region, 311, 313
middle colic vessel origin, 311, 313
duodenojejunal exure, 311–312
end-to-end anastomosis, 311
hemostatic mesenterectomy, 311
herniation, 311
metastatic lesion in, 314
patient positioning, 313
preoperative considerations, 313–314
reoperative surger y, 314
small bowel walk, 312–313
2-0 Vicryl© sutures placement, 311–312
Small intestinal carcinoid, 314
Small intestinal mesenterectomy, 131
Small intestinal peritoneal reection, 28
Splenic exure
anatomic nomenclature, 123, 126
laparoscopic/robotic mobilization,
302, 349
mesentery anatomy, 21–23
mobilization component
colic, 294–296
mesenteric, 295–296
peritoneal, 294–295
Splenocolic reection, 29
Stapled anastomosis, 348
Stoma formation and reversal
bowl and associated mesentery delivery
ileostomy reversal, 325, 327–330
Nylon tape–based technique,
323–325
stomal eversion, 325–326
end-loop ileostomy, 330
ileostomy formation, 323–324
subcutaneous adiposity, 330
transverse loop colostomy formation,
330–331
transverse mesocolon
mobilization, 331
Subperitoneal space of Oliphant, 6, 110
Superior mesenteric artery (SMA), 111,313
Surgical instrumentation, 345
T
TA45, 318
Technical nomenclature, 131, 134
Tissue sealant devices, see Harmonic
scalpel
Toldt, Carl Florian, 3–4
Toldt’s fascia (TF), 43, 67, 344
and adhesions, 66
anatonomic nomenclature,
120, 128
articially stimulating fascial
development, 67
composition, 57–58, 67
demonstration, 58
development, 57
function
in animal models, 65–66
barrier function, 64
uid absorption, 64–65
gastromesenteric conrmation, 64
nonrotation of intestinal tract, 64
future studies, 67
and radiology, 66
regional anatomy
fascial contiguity, 62
histology, 62–63
left m socolic fascia and white line
of Toldt, 59–62
mesorectal fascia, 58–60
mesosigmoidal fascia, 59, 61
right mesocolic fascia and the
white line of Toldt, 61–63
surgical implications, 66
Toldt’s observations, 6
Total mesocolic excision (TMCE), 153
Total mesorectal excision (TME), 7, 119,
131, 139, 153, 345
vs. non -T M E , 15 3
terminology, 251
Total mesosigmoidectomy, 233
Transverse loop colostomy formation,
330–331
Transverse mesocolon
anatomic nomenclature, 123
anatomy, 301
international standardization
of, 309
laparoscopic/robotic mobilization and
division, 350
greater omentum, 301–302, 305
identication of mesenteric
margin, 303
from left f midline, 305–307
mesenteric root region, 305,
308–309
middle colic adipovascular
pedicle, 303–305
operative eld, 303
from right, 305, 307
splenic exure, 302
Treves, Sir Frederick, 3–6, 11–14
2.0 Prolene
®
purse string suture, 319
V
Vicryl
®
/PDS
®
sutures, 319
Visceral adiposity, 69–71
Visceral pelvic fascia, 252
Visceral peritoneum, 49–51, 57, 101
Visual Human Project (VHP), 66, 110,
112, 145, 251, 254
Vitello-intestinal duct anchors, 42
Vol vu lus, 93–9 5
W
Waldeyer’s fascia, 28, 44, 57, 59, 67, 128,
252–253, 259, 263
“Walling o” eect, 233
Z
Z-Brush, 112, 137
0-0 Vicryl
®
sutures, 270
First published in July 2021.
New Enterprise House
St Helens Street
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UK
email: gareth.icke@davidicke.com
Copyright © 2021 David Icke
No part of this book may be reproduced in any form without permission from the
Publisher, except for the quotation of brief passages in criticism
Cover Design: Gareth Icke
Book Design: Neil Hague
British Library Cataloguing-in
Publication Data
A catalogue record for this book is
available from the British Library
eISBN 978-18384153-1-0
Dedication:
To
Freeeeeedom!
