Introduction/Background*To demonstrate the proper anatomical boundaries and surgical technique for total omentectomy on a live patient.
Methodology This surgical video was recorded at Ankara City Hospital, an ESGO Accredited Gynecologic Oncology Center.
The greater omentum attaches the stomach to the transverse colon. The double fold of the peritoneum encircling the stomach turns over itself and attaches to the transverse colon and transverse mesocolon. By the way, the greater omentum has four peritoneal folds.
The greater omentum lies cranially from the greater curvature of the stomach and proximal duodenum, traverses over the transverse colon between the hepatic flexure at the right side and splenic flexure at the left side, and afterwards lies over the small intestines covering the whole abdominal cavity.
Firstly, the posterior peritoneal fold covering the omentum which attaches to the transverse colon is cut, so an avascular plane is identified superior to the transverse mesocolon.
Secondly, after cutting the posterior peritoneal fold of the omentum between the hepatic flexure and splenic flexure (the attachments at the level of hepatic and splenic flexure are dissected), the transverse colon is grasped caudally, and the omentum is grasped cranially. By the way, the gastrocolic space is easily dissected and developed. As a consequence, the omentum is dissected from the transverse mesocolon.
The stomach and the transverse colon are separated, the omentum is found attached to the stomach, and the bursa omentalis is accessed. Afterwards, the omentum is excised from the hepatic flexure to the splenic flexure below the level of the greater curvature. If there is not any gross tumor nodule at this part, the gastro-epiploic vessels are preserved.
While excising the omental structure between the stomach and spleen, care should be taken for short gastric vessels lying here, especially at the cranial part of this area. Besides, close to the splenic hilum, the omental tissue should be discriminated from the tail of the pancreas.
Conclusion*Developing the gastrocolic space is crucial while performing a total omentectomy. In addition, the peritoneal folds of the omentum should be dissected clearly and gently.
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