Goutaro Katsuno, MD, PhD, Masaki Fukunaga, MD, PhD. Department of Surgery, Juntendo Urayasu Hospital, Juntendo University
Introduction: When we perform single-incision laparoscopic surgery for advanced transverse colon cancer, it is technically difficult to perform a complete mesocolic excision (CME) with central vascular ligation successfully. The main reason for this technical difficulty lies in the limited access to the abdominal cavity and anatomical complexity around the middle colic vessels (MCVs). We present a Pincer movement method using internal organ retractorTM to safely complete single-incision laparoscopic CME for advanced transverse colon cancer. Pincer movement method refers to an original strategy used to simplify the anatomical complexity around the MCVs by approaching the transverse mesocolon caudally and cranially.
Surgical procedures:
Step1 skin incision & setting
2.5 cm Z type skin incision is made, and access platform is placed in the small umbilical incision area.
Step2 ascending colon mobilization
Ascending colon must be fully mobilized before the pincer movement method is performed.
Step3 Pincer movement method
3-1 caudal approach
First, the omentum is divided, and the divided omentum is fully hung up toward the cranial space to maintain a working space by using internal organ retractorTM. The fusion fascia attached to inferior border of the pancreas is then transected. The pancreas’ head & body is completely separated from the transverse mesocolon. This manipulation is very useful to clearly identify the inferior border of the pancreas. As a result, intraoperative pancreatic injury can be avoided by securing free-space around the border. Next, Gastrocolic trunk of Henle and right gastroepiploic vein and accessory right colic vein (ARCV) are exposed by dissecting lymph nodes caudally. They are easy to access with the caudal approach. Finally, middle colic vein (MCV) is identified and divided at the origin.
3-2 cranial approach
Simplifying anatomical complexicity and securing free-space around the pancreas by caudal approach enables us to safely complete cranial approached LNs dissection. Ileocolic and right colic vessels and middle colic artery can be safely divided at the origin. Finally, Laparoscopic CME with central vascular ligation can be completed with confidence.
Step4 Anastomosis
Functional end-to-end anastomosis is performed extracorporeally.
Results: Single incision Laparoscopic CME with central vascular ligation was performed in 8 transverse colon cancer patients. All procedures were successful and there were no anastomotic leakages in the series.
Conclusion: Single incision laparoscopic complete mesocolic excision with central vascular ligation for advanced transverse colon cancer is safe and feasible by using Pincer movement method.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77724
Program Number: V088
Presentation Session: Friday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo