Initial Dissection

The colon is mobilized medially 4 to 5 cm below the lower pole by incising its lateral attachment; on the left side this corresponds with the white line of Toldt. Care should be taken during this mobilization: maintaining a safe distance from the colon to prevent diathermy injury and preserving the colonic mesentery. The different appearance of the fat associated with colonic mesentery (dark yellow/orange) and Gerota's fascia (pale yellow) is a useful guide to determining the correct plane. The mobilization should be carried caudally to expose the lower pole of the kidney. On the left side, mobilization should be extended cranially, sufficient to allow the spleen and tail of pancreas to fall medially and expose the hilum. On the right side, the colon should be mobilized above the hepatic flexure and the right triangular ligament incised. The duodenum, which lies immediately deep to the hepatic flexure, should also be mobilized medially.

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