Tissue Triangulation

Tissue triangulation is one of the most essential techniques in colorectal laparoscopy. The tissue is triangulated between three grasping instruments, two held by the assistant and one by the surgeon (Figure 6.10). This tension allows for precise initial incision of the peritoneum and guidance in the direction of the dissection using the third grasper. Thereafter, mesenteric vessels can be palpated and isolated with a gentle, blunt sweeping maneuver of the dissecting instrument and then coagulated or clipped. With this technique, the mesentery can be divided quickly with only minor bleeding.

Separating the greater omentum from the transverse colon should also be accomplished using tissue triangulation. Any adhesions of greater omentum to the colon/mesocolon can be divided under tension using a scissor with electrosurgery, the ultrasonic scalpel, or the LigaSure™ vessel sealer. In some patients with colitis, the greater omentum may develop vascular attachments to the colon, and dissection may be difficult and require extensive coagulation. Because the greater omentum itself is usually quite flaccid, coagulation with ultrasonic scalpel is difficult. The LigaSure™ device seems preferable to us in these cases (Figure 6.11).

Tissue Triangulation
Figure 6.10. Tissue triangulation is a key component of accurate dissection during laparoscopic surgery.
Triangulation Laparoscopy
Figure 6.11. The LigaSure™ device is used to divide vascular attachments of the omentum to the colon by applying strong traction and countertraction to the tissue.

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  • flambard
    What is trangulation in laparoscopic surgery?
    8 years ago
  • Ceredic Underhill
    What is triangulation during laparoscopic surgery?
    8 years ago

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