1. Anatomic Landmarks for Laparoscopic Colon Resection
John Marks MD
Chief: Section of Colorectal Surgery Main Line Health System
Professor: Lankenau Institute of Medical Research
Director: Fellowship in Minimally Invasive Colorectal Surgery and Rectal Cancer Management

2. Critical Anatomy Blood Vessels Nerves Attachments
Relationships to Other Organs

3. Normal Development of Intestine

4. Normal Development of Intestine- Normal Anatomy
Line of Toldtz
SMA
diagonal axis

7. Right Colon - 1 Superior mesenteric artery Ileocolic pedicle
Bare spot of duodenum
Relationship to the Pancreas
Embryologic fusion plane R colon mesentery
Right ureter

11. Right colic - either branch of ICA, MCA
A Garcia-Ruiz, JW Milsom, KA Ludwig, P Marchesa. Right Colonic Arterial Anatom. Dis Colon Rectum 1996;39(8):
56 cadavers
Ascending colon
ileocolic artery - 66%
middle colic artery %
right colic artery %
Right colic - either branch of ICA, MCA
Middle colic artery % - independent
3.6% double arteries
Anomalies - branch of hepatic artery, splenic artery

12. Image Position Lap Right Colon

13. Right Colon - 1

14. Right Colon - 2 Gastrocolic ligament Hepatorenocolic Ligament
Line of Toldt
Attachment of ileum to pelvis

16. Right Colon - 2

17. Middle Colic Right Colic Ileocolic 32.8 45.2 67.4 3 - 70 20 - 70
A Garcia-Ruiz, JW Milsom, KA Ludwig, P Marchesa. Right Colonic Arterial Anatom. Dis Colon Rectum 1996;39(8):
Length Before Branching
Mean (mm)
Range (mm)
Middle Colic Right Colic Ileocolic
32.8
45.2
67.4
3 - 70

19. Middle Colic Artery
SKIP

20. Left Colon - 1 View of perforating vein of gastrocolic ligament
Entry into lesser sac
Posterior wall of stomach
Inferior pancreas

21. Gastrocolic Ligament

22. Left Colon - 1

23. Left Colon - 2 Upper attachment Line of Toldt
Splenorenal colic ligament
Embryologic fusion plane between mesentery
Gerota’s fascia
Transverse mesocolon

24. Left Colon - 2

26. Left Colon

27. Left Colon - 3 IMV medially Gruber’s ligament IMA medially
Right ureter
Embryologic fusion plane of descending colon

28. Left Colon - 3

29. Left Colon - 4 Hypogastric nerves Left ureter Left gonadal vessel
IMA & left colic branch
White line of Toldt

30. Left Colon - 4

31. Rectum - 1 R & L pararectal sulcus R hypogastric nerves at pelvic brim
Areolar plane anterior to hypogastric nerves
Proper plane along TME
Seminal vesicles & Nervi Erigentes

32. Rectum - 1

33. Rectum - 2
R & L lateral stalk
Levator ani
Anal canal

34. Rectum - 2

35. Pelvic Floor