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THREE APPROACHES TO THE INFERIOR MESENTERIC ARTERY DURING ROBOTIC D3 LYMPHADENECTOMY FOR RECTAL CANCER
Songphol Malakorn^*, Tarik Sammour, Brian K. Bednarski, Y. Nancy You, George J. Chang
Surgical oncology, MD Anderson Cancer Center, Houston, TX

This video describes three methods for IMA division during robotic radical lymphadenectomy for rectal cancer. Standard high ligation is the simplest to perform and provides excellent mesenteric length, but relies solely on blood supply from the middle colic artery. Low ligation with ascending left colic artery preservation is more complex technically, but affords excellent vascular supply while potentially limiting mesenteric length. The central vascular sparing technique is the most complex to perform, but allows excellent mesenteric length due to the presence of two separate points of mesenteric division, while also potentially improving blood supply due to improved collateralization.

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