Transilluminate the mesentery to study the
pattern of blood supply to the bowel segment.
Select the line of vascular section. Choose
a shallow wedge of mesentery for benign lesions and deeper wedge for malignancies.
Incise the the peritoneum along this line
with scissors on both aspects of the mesentery.
Create a small mesenteric window adjacent
to the bowel at one end of transection by small curved artery forceps.
Insinuate the forceps back through the mesentery
to isolate a small segment of mesentery with its vessels.
Divide the vascular pedicle between ligatures
or staples and continue to the other end of the bowel resection margin. (In
thin mesentery stapling can proceed without having to create mesenteric windows,
increasing speed further).
Disadvantages of staplers
A tendency to jam and recoil if handled
improperly, with increased risk of mesenteric tearing.
Limited to tissues that can be compressed
to the cartridge size.
