PMC9381358_01
PMC9381358_02
(
A
) Port layout. Port layout is shown. (
B
) Schema for the mucosectomy and mesenteric dissection. The mucosectomy was stared at 1 cm from the dentate line (
a
). Some sutures were applied to the removing mucosa, and mucosectomy was performed to the oral side with traction (
b
). The dissection was advanced to the level of the peritoneal reflection, and the circumferential incision was made at the folded muscle to reach the peritoneal cavity (
c
). A vessel sealing system (VSS) was inserted into the abdominal cavity through the incision, and the mesentery of the pull-through intestine was coagulated and divided (
d
) while checking the blood flow with indocyanine green under observation by a laparoscope.
10-1055-s-0042-1751051-i220650cg-1.jpg
PMC9381358_02_10-1055-s-0042-1751051-i220650cg-1.jpg
FI220650cg-1
After pneumoperitoneum was established under 7 mm Hg with 3 L/min CO 2 , a 5-mm 30-degree laparoscope was inserted, and the operator's right-hand port (5-mm) was placed in the lower-right abdomen ( Fig. 1A ). Then, entering abdominal cavity through the anus, a 5-mm vessel sealing system (VSS; Ligasure-Maryland, Medtronic, MN, United States) was inserted transanally into the abdominal cavity under observation by a laparoscope, to dissect the mesentery of the narrow segment of the colon ( Fig. 1B ).
(
A
) Mesenteric blood flow assessment. The mesentery blood flow in the pulled-through sigmoid colon was confirmed with indocyanine green (ICG) fluorescence. (
B
) Evaluation of blood flow in the anastomotic sigmoid stump. Sufficient blood supply in the pulled through sigmoid colon was confirmed with ICG fluorescence.
10-1055-s-0042-1751051-i220650cg-2.jpg
PMC9381358_02_10-1055-s-0042-1751051-i220650cg-2.jpg
FI220650cg-2
Tokyo, Japan]) was dissolved in 10 mL of distilled water. The mesentery blood flow in the pulled-through colon was confirmed under a fluorescence scope, with the intravenous administration of 1 mL (0.5 mg/kg) of ICG solution ( Fig. 2A ). Sufficient blood supply in the pulled-through colon was also confirmed from the perineal side with ICG fluorescence again ( Fig. 2B ), and anal anastomosis was made with 5-0 monofilament sutures ( Video 1 ).