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Laparoscopic complete mesocolic excision (CME) right hemicolectomy with intracorporeal anastomosis

SAE Yeo, MBBS, MMed (Surg), FRCS (Ed)
Epublication WebSurg.com, Feb 2018;18(02). URL: http://websurg.com/doi/vd01en5198

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Complete mesocolic excision (CME) in colon cancer surgery has recently gained popularity as increasing evidence points to improved oncological clearance with superior lymph node yield, bigger tumor clearance margins, and higher quality surgical specimens. There are also some indications that it may lead to improved oncological outcomes. The tenets of CME include high vascular ligation at the root of the vessel, dissection along the embryological planes of the colonic mesentery, and adequate margins of bowel from the tumor. Although the technique was initially described and achieved via a laparotomy, laparoscopic CME was also performed, although it was noted to be technically challenging. The right colon and the variability of vascular anatomy add to the difficulty of the procedure. Extracorporeal anastomosis is commonly performed for right hemicolectomy in most centers. There are some reported advantages to the intracorporeal anastomosis, namely a potentially higher lymph node yield, a smaller skin incision, and the ability to extract the specimen via a Pfannenstiel’s incision, which has lower rates of incisional hernia. This video features a laparoscopic CME right hemicolectomy with intracorporeal anastomosis for a malignant polyp.