Laparoscopic Right Hemicolectomy Using A Cranial-First Approach: Technical Description and Early Outcomes

There are various surgical approaches for laparoscopic radical right hemicolectomy. However, the Henle's trunk and middle colic vessels often reveal anatomical variations, and improper handling may lead to vascular injury. This protocol presents a "cranial-first" approach combined with complete mesocolic excision (CME) to attempt to overcome the aforementioned technical difficulties. 86 cases were collected from September 2023 to April 2026. First, the gastrocolic ligament was opened to expose the right gastroepiploic vessels and the pancreatic head. The colic branches of Henle's trunk and the middle colic vein (MCV) were dissected and ligated along the inferior border of the pancreas. Dissection then continued caudally along the superior mesenteric vein (SMV) and laterally along the retroperitoneal plane to the duodenum. Second, a medial approach was adopted. The assistant lifted the transverse and the ileocolic mesocolon. The peritoneum was incised between the jejunal origin and the ileocolic projection. The lymphatic and adipose tissue on the superior mesenteric artery (SMA) and SMV surface was dissected medially to laterally. The middle colic artery (MCA) or its right branch and the ileocolic vessels were ligated. Finally, the ileocecal mesentery was incised, and the right mesocolon was completely mobilized along Toldt's space. The median operative time was 182.0 min, the blood loss was 45.0 ml, and the number of lymph node dissections was 28.0. The median time to flatus was 3.0 days, and the postoperative hospital stay was 6.0 days. Wound infection occurred in 4 patients, and ileus occurred in 2 patients, but no postoperative death occurred. Preliminary results indicated that this approach was safe and feasible.