Dechang Diao, PhD, Xinquan Lu, MD, Wei Wang, MD, Liaonan Zou, MD, Yaobin He, MD, Hongming Li, Wenjun Xiong, MD, Ping Tan, MD, Yansheng Zheng, MD, Lijie Luo, MD, Jin Wan, PhD. Department of Gastrointestinal (Tumor) Surgery, Traditional Chinese Medicine Hospital of Guangdong Province, The Second Affiliated Hospital of Guangzhou University of traditional Chinese Medicine
Background: Due to the emphasis of oncologic principle, complete mesocolic excision (CME) for laparoscopic right hemicolectomy was recommended. According to European CME and Japanese guidelines, the lymph nodes around the right size of the superior mesenteric artery (SMA) should be dissected away and removed en bloc with the specimen. However, due to the technically challenging and fearing of the possible related complication, most surgeons around the world adopted the dissection carrying out along the axis of the superior mesenteric vein (SMV). Herein, we described an artery first approach for laparoscopic radical extended right hemicolectomy with complete mesocolic excision.
Methods: First, the junction of right mesocolon and mesostenium was incised and the retroperitoneal in front of SMA is cut from the distal to proximal end. The SMA, ileocolic artery (ICA), right colic artery (RCA) and middle colic artery (MCA) were exposed and separated, and the lymph nodes along the right size of SMA were dissected. Then the SMV was separated and the ileocolic vein (ICV), right colic vein (RCV) and middle colic vein ( MCV) were isolated, ligatured and cut at their roots, and Henle’s trunk was exposed. Second, the Toldt’s fascia was dissected and expanded lateral to the ascending colon, cranial to the pancreas head, with the accessory right colic vein (ARCV), right gastroepiploic vein (RGEV) and right gastroepiploic artery (RGEA) divided and cut at their roots. Third, the greater omental was dissected on the right size 2/3 and the NO. 6 lymph nodes were dissected followed by complete mobilization of the caudal root of the mesentery and lateral attachments of the ascending colon. Finally, ZT glue was applied to block the lymphatics surrounding SMA and SMV.
Results: There were 6 male and 5 female patients, with a mean age of 67.2 years (range, 41–85) and a mean BMI of 24.6 kg/m2 (18.3–37.7). All procedures were successful without any conversion to open surgery or any serious perioperative complications. The mean operation time was 192.5 min (range, 145–240), and the mean blood loss was 55.0ml (range, 10–200). The mean number of harvested lymph nodes was 25 (range, 13–44)
Conclusion: The initial results suggest that the reported approach may be a feasible and safe procedure and more in accordance with the principles of CME.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79569
Program Number: V139
Presentation Session: Colorectal Video Session
Presentation Type: Video