Step-by-step bottom-up laparoscopic right hemicolectomy with complete mesocolic excision: a technical video...

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Colorectal Surgery

Background:

• Laparoscopic right hemicolectomy with complete mesocolic excision (CME) is crucial for oncologically sound colorectal cancer resection.
• Extended lymphadenectomy (D2/D3) benefits remain debated, and vascular variability increases procedural complexity.
• The bottom-up approach is presented as a method to address these challenges in laparoscopic CME.

Purpose of the Study:

• To describe the bottom-up approach for laparoscopic right hemicolectomy with complete mesocolic excision (CME).
• To highlight the technique's potential for precise dissection and oncologically sound tumor and mesentery resection.
• To emphasize the method's safety profile, particularly regarding vascular structures.

Main Methods:

• Patient positioning in lithotomy with suprapubic trocar placement.
• Peritoneal incision near the ileocecal junction, followed by dissection along avascular planes.
• Identification and ligation of key vascular structures (ileocolic artery/vein, superior mesenteric vein tributaries) with en bloc specimen retrieval.

Main Results:

• The bottom-up approach facilitates precise dissection around critical vascular structures.
• Complete mesocolic excision (CME) is achieved with the mesentery preserved intact.
• The technique allows for a safe, en bloc resection of the tumor and surrounding mesentery.

Conclusions:

• The bottom-up approach offers a safe and effective method for laparoscopic right hemicolectomy with CME.
• This technique potentially minimizes the risk of vascular injury during complex oncologic resections.
• It enables precise dissection and ensures an oncologically sound en bloc resection.