Identification of the Artery

To enable proper identification of the artery, the Trendelemburg position may be further increased so as to draw the loops of small bowel out of the pelvis. The plane of the right iliac artery is identified and the pre-aortic plane is opened. The IMA is identified and cautiously isolated (Figs. 12, 13). The magnification of the laparoscope enables the identification of the nerve fibres that must be spared posteriorly (Fig. 14). The artery is clipped and divided, and this portion of the mesentery of the left colon is sharply dissected from the retroperitoneum and the ureter is recognised (Fig. 15). This dissection of the mesentery of the left colon from the retroperitoneum must be completed as far as possible in the middle to lateral direction, so that little remains to perform from the left abdominal gutter.

Fig. 12. Pl, nervous plexus; IMA, inferior mesenteric artery; Co, colon; Gv, gonadal vessels; Ur, ureler. The IMA is identified and the peritoneum is opened just underneath it
Fig. 14. IMA, inferior mesenteric artery; Pl, nervous plexus
Fig. 13. IMA, inferior mesenteric artery; Ao, aorta; IA, right iliac artery
Fig. 15. IMA, inferior mesenteric artery; Ur, ureter; Gv, gonadal vessels

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