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Bach Mai Procedure for complete mesocolic excision, central vascular ligation, and D3 lymphadenectomy in total
Ngoc Hung Nguyen1, Xuan Vinh Vu1,2, Vu Quang Nguyen1
1Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam.
Insights
The Bach Mai Procedure offers a safe and feasible approach for total laparoscopic right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy. This novel technique demonstrates promising results with no severe complications in initial cases.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Total laparoscopic right hemicolectomy with complete mesocolic excision (CME), central vascular ligation (CVL), and D3 lymphadenectomy is a complex procedure.
- Existing techniques present significant challenges for gastrointestinal surgeons.
Purpose of the Study:
- To introduce and evaluate the preliminary experience of the Bach Mai Procedure, a novel combined approach for total laparoscopic right hemicolectomy (tLRH).
- To detail the technical aspects of this innovative technique, including its multi-approach strategy and early terminal ileum resection.
Main Methods:
- The Bach Mai Procedure involves a multi-step dissection: cranial, medial-to-lateral, and caudal approaches.
- Key steps include central vascular isolation and ligation (CVL), early terminal ileum resection, and D3 lymphadenectomy.
- The technique facilitates radical ligation of ileocecal and right colic arteries and release of the colon.
Main Results:
- Thirty-two patients with right-sided colon malignancies underwent tLRH (D3, CME/CVL) using the Bach Mai Procedure over 12 months.
- The median lymph node yield was 38 (range: 101).
- No severe postoperative complications (grade 3 or higher) or in-hospital mortality were observed.
Conclusions:
- The Bach Mai Procedure is a technically feasible and safe method for performing tLRH (D3, CME/CVL).
- This novel approach, combining specific dissection strategies and early ileum resection, shows potential for improved surgical outcomes.
- Further research and long-term follow-up are necessary to validate the efficacy of this technique.
Purpose:
Total laparoscopic right hemicolectomy with complete mesocolic excision (CME), central vascular ligation (CVL), and D3 lymphadenectomy is still the most challenging colon procedures for gastrointestinal surgeons. We herein report the technical details and our preliminary experience of Bach Mai Procedure - a novel-combining (cranial, medial to lateral, and caudal) approach with early resection of the terminal ileum.
Methods:
The dissection stage was central vascular isolation and ligation by a combined multiple approaches in the following four steps: cranial approach, dissecting along the inferior aspect of pancreatic isthmus to reveal the middle colic vessels and the anterior aspect of the superior mesentery vein and then exposed the right gastroepiploic vein and the trunk of Henle; medial-to-lateral approach, exposing the surgical axis - the superior mesenteric vascular axis and then early resection of the terminal ileum to open the dissection from the bottom up; and caudal approach, radical ligation of the ileocecal artery and right colic artery (central vascular ligation), lymph node dissection (D3 lymphadenectomy), and resecting the Toldt fascia of the colon to release the entire right colon from the abdominal wall.
Results:
In 12 months, there were 32 cases of primary right-sided colon malignancies that have undergone tLRHD3, CME/CVL based on the Bach Mai Procedure. In 3 cases (9.4%), the tumor site was hepatic flexure. The median of lymph node number (LNN) was 38, with the maximum number which was 101. No serious postoperative complications (grade 3 or higher) neither inhospital mortality was detected.
Conclusion:
This Bach Mai procedure, a novel-combining approach with early resection of the terminal ileum, is technically feasible and safe for tLRHD3, CME/CVL. Further investigations and follow-up must be proceeded to evaluate the long-term outcomes of our technique.
