Hepatic Flexure Mobilization
Mobilization of the hepatic flexure is performed for right colectomy, total colectomy, and total proctocolectomy. Details of the hepatic flexure mobilization are incorporated in the operative steps of each respective chapter.
KEY STEPS
1. Patient rotated fully to the left and slightly reverse Trendelenburg.
2. Ileocolic pedicle defined and divided, protecting ureter and duodenum.
3. Full medial to lateral mobilization of cecum, ascending colon, and hepatic flexure.
4. Hepatic flexure mobilization completed using a superior approach.
5. Traction applied anteriorly and inferiorly to lift flexure away from retroperitoneum and show previously dissected space.
ADDITIONAL ADVICE
1. Mobilization of the hepatic flexure can be difficult. In patients who are very obese it can be hard to complete the ascending colon mobilization to the level of the hepatic flexure. In these cases, positioning the patient in reverse Trendelenburg can facilitate the release of the hepatic flexure.
2. Inserting an instrument in the right upper quadrant can also facilitate mobilization. This additional port may provide additional traction on the hepatic flexure.
3. The operator may find it more comfortable to stand between the patient’s legs and use the two inferiorly placed ports as the main dissection instruments.
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