Wenjun Xiong, Wei Wang, Jin Wan. Guangdong Provincial Hospital of Chinese Medicine
In 2016, we first describe a caudal-to-cranial approach for laparoscopic right hemicolectomy. This approach was a safe alternative to the conventional medial-to-lateral approach, especially for inexperienced surgeons. As we all know, the duodenum is an organ passing through the retroperitoneum. Thus, we report a caudal-to-cranial approach guided by the duodenum for laparoscopic right hemicolectomy.
Step 1: Right Toldt's space dissection
The “membranous bridge” between the mesentery and retroperitoneum was cut guided by the duodenum. The right Toldt's fascia and the pancreatic duodenal anterior space are dissected with the pancreas and the posterior paries of superior mesenteric vein (SMV) exposed.
Step 2: Central vascular ligation
The mesocolon between the ileocolic vessels (ICVs) and SMV is dissected and the peritoneum on the surface of SMV is cut. The whole SMV is exposed. Then the ICVs, right colic vessels (RCVs), Henle’s trunk and the middle colic vessels (MCVs) are exposed. In this patient, the MCVs are defect. A central vascular ligation is performed to achieve CME.
Step 3: Cranial and lateral mobilization
The gastrocolic omentum is dissected for full mobilization of the mesocolon containing 10 cm of normal colon distal to the lesion. And the lateral attachments of the ascending colon is also separated.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93391
Program Number: V252
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop