A standardized approach for complete mesocolic excision (CME) for right colon cancer
Epublication WebSurg.com, Nov 2019;19(11). URL: http://websurg.com/doi/lt03en17849
In this key lecture, Dr. Antonello Forgione presents a clear and precise description of the most important anatomical points as well as the surgical technique for complete mesocolic excision (CME) during a right laparoscopic colectomy, in cases of cancer. As described in the video, four ports are used, all located on the left flank. A caudocranial dissection of the mesocolon is performed along the superior mesenteric vein to the inferior margin of the pancreas, exposing, ligating and dividing the ileocolic, right and middle colic vessels in their origins. The gastrocolic trunk is completely dissected and the upper right colic vein is cut and divided. The transverse colon and the terminal ileum are divided, the colon is mobilized, and the ileo-transverse intracorporeal stapled anastomosis is fashioned. Laparoscopic CME is feasible and very useful. However, it is necessary to have an extensive knowledge of the vascular anatomy of the right colon, as well as an experience in advanced laparoscopic techniques to obtain the expected outcomes. Finally, Dr. Forgione provides recommendations to perform the surgery in obese patients.