COMPLETE MESOCOLIC EXCISION FOR RIGHT-SIDED COLON CANCER

Category*

General Surgery

Description

ABSTRACT:
Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) is a
promising alternative to standard hemicolectomy for locally advanced rightsided
colon cancer. CME aims to improve oncologic outcomes by central
vascular ligation (CVL), facilitate a greater lymph node yield, and dissection
according to the embryologic plane.
I present a standardized robotic right hemicolectomy with CME and CVL
performed with the Da Vinci SI platform. Five trocars are required: a 12mm
umbilical trocar for the scope, two 8mm ports in the left hypochondrium and
suprapubic for the robotic instruments, a 5-8mm subxiphoid trocar for exposure,
and a 12-mm trocar in the left flank for laparoscopic assistance. Monopolar
scissors and bipolar forceps allow a cost-effective and precise technique, while
other energy devices may be used depending on the surgeon's judgment and
resources availability. Dissection is performed by a bottom-up approach, from
medial to lateral, beginning with mobilization and ligation of the ileocolic
vessels, then proceeding along the superior mesenteric vessels to separate the
mesocolon, exposing the head of the pancreas and the duodenum by dissecting
Fredet's fascia. Vascular structures are isolated individually and ligated
centrally. These basic principles allow removal of the right nodes "en-bloc" with
the pertinent mesentery and colon. After proximal and distal resections, under
the angiographic assistance of indocyanine green fluorescence to verify
intestinal perfusion, an intracorporeal ileo-transverse latero-lateral anastomosis
is performed using a motorized linear stapler and hand-sewn visceral and
peritoneal closure. The procedure ends with specimen removal in a plastic bag
through a Pfannenstiel incision. Routinely, drainage is not used.