Hemicolectomy left, open, curative

Median laparotomy with the incision passing the umbilicus on the left. Transect the subcutaneous tissue and fascia with diathermy.

Insert a circular wound edge protector followed by a retractor. Assess tumor size and location. The tumor is palpable just inferior to the splenic flexure. Explore the abdomen to rule out metastases.

The upstream resection margin depends on the size and location of the tumor. After identifying the medial colic artery encircle the transverse colon slightly downstream of the artery. Because of the advanced age and distant tumor in the present case, this structure will not be included in the resection.

The small intestine is retractedto the right and the descending colon and sigmoid freed from their lateral attachments. The plane of dissection must leave the peritoneal reflection at the level of the tumor, since the tumor appears to break through the serosa.

Open the lesser peritoneal sac by dividing the greater omentum off the transverse colon to the left of the planned margin of resection. In order to mobilize the splenic flexure, divide the splenocolic ligament between clamps.

Note: The omental bursa may also be opened by dividing the gastrocolic ligament superior to the colon to the left of the proximal resection margin.