Laparoscopic right hemicolectomy (mesocolic excision) in advanced right colonic tumor with parietal fixation (T4)
Epublication WebSurg.com, Sep 2015;15(09). URL: http://websurg.com/doi/vd01en4573
Similar to TME in rectal cancer, a comparable approach for the surgical resection of colonic cancers is described as complete mesocolic excision (CME), which includes central vascular ligation and dissection in the mesocolic space. According to a recently published Danish study, a 4-year disease-free survival (DFS) in the CME group was 85.8% whereas it was 75.9 % in the conventional group. Here, we present a video demonstration of laparoscopic right radical hemicolectomy in which complete mesocolic excision was performed. The mesocolic layer was identified as a shiny avascular film, which was preserved during the procedure in order to limit tumor dissemination. In this medial to lateral approach, the first duodenum is identified by incising the peritoneum and using a gauze piece for dissection purposes in an avascular plane, making sure to preserve the mesocolon. The right colic vessel is identified and clipped. The right branch of the middle colic artery and the ileocolic vessel are ligated. All fibrotic and adipose tissues are swept along with the specimen, and the ureter and gonadal vessels are dissected away. Lateral mobilization is achieved, and the specimen is then removed through small transverse incision to prepare for an extracorporeal ileo-transverse anastomosis.