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Published on: August 8, 2025
Usefulness of a Precursory Small Epigastric Midline Incision during Laparoscopic Right Hemicolectomy
Ryuichi Oshima1, Yukihito Kokuba1, Tsukasa Shimamura1
1Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Kanagawa, Japan.
Objectives:
During laparoscopic right hemicolectomy, many surgeons make a small incision near the umbilicus after the routine intraperitoneal operation. In this study, we created a precursory small epigastric incision at the center of a line connecting the xiphoid process and umbilicus (the M point, an empirically determined position) at the start of surgery prior to laparoscopic manipulation. This study aimed to determine whether the small incision at the center of the M point was a suitable position through which the right hemicolon is extracted.
Methods:
The subjects included 148 patients who underwent laparoscopic right hemicolectomy at our hospital between January 2013 and December 2019. We measured the distance between the M point and the gastrocolic trunk (GCT) root at the base of the transverse mesocolon and the middle colic artery (MCA) root on preoperative contrast-enhanced computed tomography images.
Results:
We found that the GCT and MCA roots are located within a radius of 1.5 cm from the M point, suggesting that the base of the transverse mesentery was located almost directly below the M point. Comparisons based on sex differences and body mass index (BMI) also revealed that the transverse mesocolon root is closer to the M point in men and overweight patients.
Conclusions:
From these results, the placement of a precursory small epigastric midline incision not only allows for a safe insertion of the first laparoscopic port in a short period of time but also facilitates safe transection and anastomosis due to the proximity of the M point to the transverse mesocolon root.
Insights
A precursory epigastric incision at the M point facilitates safe laparoscopic right hemicolectomy. This approach allows for quick port insertion and safe surgical manipulation due to the M point
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Anatomical Studies
Background:
- Laparoscopic right hemicolectomy often involves a post-operative umbilical incision.
- A precursory epigastric incision at the M point (midpoint between xiphoid and umbilicus) is proposed.
- The suitability of the M point for specimen extraction needs evaluation.
Purpose of the Study:
- To determine if the M point is an optimal location for specimen extraction during laparoscopic right hemicolectomy.
- To assess the anatomical relationship between the M point and key vascular structures.
Main Methods:
- Retrospective analysis of 148 patients undergoing laparoscopic right hemicolectomy (2013-2019).
- Preoperative contrast-enhanced CT scans were used to measure distances.
- Measurements included the M point to the gastrocolic trunk (GCT) root and middle colic artery (MCA) root.
Main Results:
- The GCT and MCA roots are located within 1.5 cm of the M point.
- The transverse mesocolon root is generally positioned directly below the M point.
- The transverse mesocolon root is closer to the M point in men and overweight individuals.
Conclusions:
- The M point is a suitable location for a precursory epigastric incision in laparoscopic right hemicolectomy.
- This incision allows for safe and rapid laparoscopic port placement.
- Proximity of the M point to the transverse mesocolon root facilitates safe transection and anastomosis.
