Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node...

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Colorectal Surgery

Background:

• Laparoscopic right hemicolectomy (LRH) is effective but technically demanding due to vascular complexity and anatomical variations.
• Traditional surgical approaches include lateral-to-medial and medial-to-lateral techniques.
• Advancements in surgical technology have introduced multiple approaches for LRH.

Purpose of the Study:

• To introduce and evaluate a novel caudal-to-cranial approach for laparoscopic right hemicolectomy.
• To assess the feasibility of combining this approach with complete mesocolic excision (CME) and D3 lymph node dissection.
• To determine if this method improves anatomical orientation and procedural safety.

Main Methods:

• A caudal-to-cranial surgical approach for LRH was developed and applied.
• The technique prioritizes establishing anatomical planes before vascular dissection.
• The approach was combined with complete mesocolic excision (CME) and D3 lymph node dissection.

Main Results:

• The caudal-to-cranial approach facilitated precise vascular management by defining anatomical planes early.
• This method enhanced anatomical orientation, potentially reducing operative difficulty.
• Initial experiences indicate the approach supports thorough lymph node dissection, proving feasible for CME and D3 dissection.

Conclusions:

• The caudal-to-cranial approach is a feasible and potentially safer method for laparoscopic right hemicolectomy.
• This technique supports comprehensive lymph node dissection, including CME and D3 levels.
• Further investigation is warranted to validate its benefits in a larger cohort.