Shun Ishiyama, PhD, MD, Kota Amemiya, MD, Yuki Tsuchiya, MD, Hirokazu Matsuzawa, MD, Shingo Kawano, PhD, MD, Masaya Kawai, PhD, MD, Koichiro Niwa, PhD, MD, Kiichi Sugimoto, PhD, MD, Hirohiko Kamiyama, PhD, MD, Makoto Takahashi, PhD, MD, Hiromitsu Komiyama, PhD, MD, Yutaka Kojima, PhD, MD, Atsushi Okuzawa, PhD, MD, Yuichi Tomiki, PhD, MD, Tetsu Fukunaga, PhD, MD, Yoshiaki Kajiyama, PhD, MD, Seiji Kawasaki, PhD, MD, Kazuhiro Sakamoto, PhD, MD. Juntendo University Faculty of Medicine, Tokyo, Japan
INTRODUCTION: Total mesorectal excision is known to be a gold standard surgical procedure for the rectal cancer. Subsequently complete mesocolic excision(CME) is recognized as an essential surgical procedure for the colon cancer. The transverse colon is relatively minor location for colon cancer. Variety of vessels and mobilization of splenic flexure and dissection close to pancreas make operations for the transverse colon cancer complicated. Laparoscopic transverse mesocolic excision in our hospital is presented.
METHOD: laparoscopic surgery is conducted with five trocars under the lithotomy position. Inferior mesenteric vein is cut after dissection of the descending colon with medial approach. The lower edge of pancreas is exposed near the inferior mesenteric vein and is dissected along toward the tail of pancreas. The splenic flexure is mobilized with lateral approach and the dissection between transverse mesocolon and the lower edge of pancreas is continued in the direction to the pancreas head. Coming to the exposure of superior mesenteric artery and vein, the origin of middle colic artery and vein are cut. The transverse mesocolon is separated from the pancreas head and the duodenum with preserving the gastrocolic trunk of Henle and the right gastroepiploic vein. The hepatic flexure is mobilized and CME for the transverse colon is finished. This method, the ‘tail to head of pancreas’ approach, we called, was performed from September 2015. This method is well performed with one series of surgical view, and seems to be a simple procedure as CME with central vascular ligation for the transverse colonic cancer. There were no intraoperative complications, and one postoperative pancreatitis with grade ? of Clavien-Dindo classification of surgical complications.
CONCLUSION: Our method, the ‘tail to head of pancreas’ approach, with transverse mesocoloc excision is simple, safe and feasible.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88092
Program Number: P244
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster