Laparoscopic radical extended right hemicolectomy using a caudal-to-cranial approach

Liaonan Zou, Guobin Chen, Wenjun Xiong, Delong Mo, Yaobin He, Hongming Li, Wei Wang, Ping Tan, Jin Wan. Guangdong Province Hospital of Chinese Medicine

Objective: We report a caudal-to-cranial approach for laparoscopic radical extended right hemicolectomy.

Methods: Firstly, a ‘yellow-white borderline’ between right mesostenium and retroperitoneum in the right iliac fossa is dissected as the entry to separate the fusion fascial space between the visceral and parietal peritoneum. The right Toldt’s fascia is dissected and expanded medial to the periphery of the SMV, cranial to pancreas head and lateral to ascending colon. The posterior paries of ileocolic vessels (ICV), right colic vessels (RCV), Henle’s trunk and middle colic vessels (MCV) are exposed. Secondly, the mesocolon between ICV and superior mesenteric vein (SMV) is dissected safely and ICV, RCV, right gastroepiploic vessels and MCV are divided and ligated at root easily because of the separated retroperitoneal space. The lymph nodes along the SMV are dissected in a caudal-to-cranial approach. Thirdly, the greater omental were dissected to fully mobilize the mesocolon followed by the lateral attachments of the ascending colon were completely mobilized.

Conclusions: The initial results suggest this apparoach may be a safe alternative to conventional medial-to-lateral approach especially for unexperienced surgeons. The main advantages in present approach contain easy access to retroperitoneal space by protecting ureter, safe lymph nodes dissection along SMV and potentially shorten learning curve.

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