Total laparoscopic right colectomy: The duodenal window first approach

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Total laparoscopic right colectomy (TLRC) is a complex procedure demanding advanced laparoscopic skills.
• Accurate identification of dissection planes and management of vascular pedicles are critical for oncological resection and stump viability.

Purpose of the Study:

• To describe and evaluate a novel
• duodenal window
• approach for TLRC using three ports.
• To assess the safety, feasibility, and outcomes of this technique.

Main Methods:

• A duodenum-first approach for TLRC was employed using three trocars.
• Key steps included dividing the
• duodenal window
• , identifying ileocecal and right colic vascular pedicles, and performing an intracorporeal stapled anastomosis.

Main Results:

• Nineteen patients underwent TLRC with a median operative time of 178 minutes and median blood loss of 60 mL.
• The conversion rate was 15.8%, with no reported injuries to the urinary tract, vasculature, or duodenum. Anastomotic fistula was also absent.
• Cancer patients (79%) achieved 100% R0 resection with a median of 16 lymph nodes harvested. Morbidity was predominantly minor (Clavien-Dindo I-II, 52.6%), with severe morbidity (Clavien-Dindo ≥ III) at 10.5%.

Conclusions:

• The
• duodenal window
• approach to TLRC is technically feasible and safe.
• This technique facilitates early access to the duodenum and simplifies the management of critical vascular pedicles.
• The approach demonstrates good oncological outcomes and patient recovery.