Transverse colectomy using indocyanine green with flexure-mobilization first approach

Laparoscopic transverse colectomy is technically demanding because of the non-standardized surgical procedure and complicated vascular anatomy. To perform transverse colectomy, both flexures should be mobilized, and lymph node dissection around the middle colic artery should be performed. Several surgical videos have introduced middle colic artery dissection as the first approach with both flexures being subsequently mobilized. Sometimes, however, flexure mobilization can be difficult after lymph node dissection around the middle colic vessels due to an unfamiliar surgical plane, while the direct approach to the middle colic artery is also technically challenging because of anatomical difficulty. Indocyanine green (ICG) is widely used in the surgical field not only for detecting lymph nodes and perfusion but also for clarifying anatomical structures like the vascular and biliary systems. Thus, the authors here detail a laparoscopic transverse colectomy using ICG and both flexure-mobilization first approach.