Mobilizing the colon
- The mobilization of the descending colon along the white line of Toldt is the first step in left sided cases. You proceed until you can appreciate the renal hilus and renal vein.
- In right sided cases, you mobilize the ascending colon until you identify the descending part of the duodenum. By mobilizing this medially, you meet the inferior caval vein and renal vein.
- In right sided cases, the mobilization of the ascending colon is not obligatory and you can start with the incision of Gerota’s fascia at the lower liver border to mobilize the upper pole of the adrenal gland. You prolong the incision in Gerota’s facia medially until you meet the inferior caval vein shining through a small peritoneal triangle at the lower liver border. Typically, at this level there is no overlying fat over the caval vein.