Laparoscopic right hemicolectomy with CME: standardization using the "critical view" concept.

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Surgical Anatomy

Background:

• Complete mesocolic excision (CME) is a key oncologic principle for right hemicolectomy.
• Laparoscopic CME is technically challenging and carries risks of complications.
• A standardized procedure is needed to minimize hazards and aid teaching.

Purpose of the Study:

• To develop a standardized procedure for laparoscopic right hemicolectomy with CME.
• To define critical anatomical landmarks and dissection planes.
• To create a safe and efficient teaching platform.

Main Methods:

• An expert group developed consensus on surgical anatomy and dissection sequence for laparoscopic CME.
• An "open book" anatomical model was created, detailing dissection planes, vascular relations, and radicality criteria.
• The procedure was structured around eight safety-focused milestones, evaluated using cadaveric specimens and videos.

Main Results:

• The "open book" model visually represents key anatomical structures and dissection planes.
• Eight preparative milestones with critical safety views were defined for the dissection sequence.
• The sequence prioritizes control during central vascular dissection, with defined alerts for incorrect dissection.

Conclusions:

• The developed anatomical model and structured dissection sequence offer a safe and efficient method.
• This approach provides a valuable platform for teaching laparoscopic right hemicolectomy with CME.
• Utilizing critical views as safety checkpoints enhances procedural safety and learning.