Retroperitoneal approach for right hemicolectomy: two faces of one technique

Laparoscopic surgery is the standard of care for many colon cancer procedures but in patients with high BMI, extensive adhesions, or significant comorbidities, the conventional approach can be technically challenging. The retroperitoneal approach (BRIDGE-technique)* which provides direct access to the retroperitoneal space offers an alternative that enables early vascular control and lymph node dissection without entering the abdominal cavity.

We demonstrate two different techniques for port placement in the retroperitoneal approach for right side colon cancer. Three separate trocar placements and Single-port access. A three-trocar approach was used in a patient with prior laparotomy and extensive adhesions. It allowed early identification and control of vascular structures, safe D3 lymph node dissection, and minimized the need for adhesiolysis. The second patient presented with an unusual vascular anatomy. She was operated on using single-port technique. Precise interfascial dissection enabled exposure of the duodenum, pancreas, and major mesenteric vessels, including the ileocolic and middle colic arteries and veins.

This detailed procedural demonstration of both surgical techniques was illustrated by a video and accompanied by a case series of five patients. The procedures were successfully completed in all patients (BMI range 18.5-32.8 kg/m²). Operative times ranged from 185 to 315 min, and blood loss was minimal (50-100 mL) across all cases. No intraoperative or postoperative complications were observed confirming the safety and feasibility of both techniques.

Retroperitoneal access by either the single-port or three-trocar technique, can be implemented for vascular control and lymph node dissection in complex right colon cancer cases. *BRIDGE-technique: Begin with Retroperitoneal dissection, then Intraabdominal Dissection with laparoscopy for Gastrointestinal Excision.