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Laparoscopic right hemicolectomy with complete mesocolic excision plus D3 lymphadenectomy (CME + D3): a new medial approach for central vascular ligation

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Abstract

Due to the high risk of vascular injuries, it remains a technical challenge and time-consuming procedure for surgeons to perform CME and D3 lymph node dissection in laparoscopic right hemicolectomy. To overcome this difficulty, we developed a novel method of the vessel’s management for central vascular ligation (CVL). The key feature of this new approach focused on vascular dissection in two aspects. The first one was to expose the superior mesentery vein (SMV) and the branches of the superior mesentery artery (SMA) at their roots from left to right after dividing the peritoneum near the left border of SMV, which has the advantage of exposing SMV and controlling bleeding. The second was to selectively ligate the colic tributaries of gastrocolic trunk of Henle (GTH) after expanding its surrounding spaces. We named this technique the “new approach (NA)”. Thirty-eight patients who underwent laparoscopic right hemicolectomy with the new approach (NA) were retrospectively analyzed and compared with data from 35 patients, who underwent the conventional medial approach (TA) performed by the same surgical team from April 2017 to March 2021. There was no significant difference between the two groups in baseline data (all p > 0.05). All 38 operations were completed with this procedure successfully. The NA approach was associated with a shorter operation time (190.5 min vs.215.5 min; P < 0.05) and a smaller blood loss (50 ml vs. 95 ml; P < 0.05) compared with the conventional approach. Two cases of vascular injuries occurred in the TA group and had been managed laparoscopically. The lymph nodes count (15 vs. 16; P > 0.05) was not significantly different; additionally, no difference was observed regarding anastomotic leakage (both n = 0) and postoperative complications (3/31 vs. 3/30; P > 0.05). No mortality was observed. NA is feasible and can be an optional method of vessel's management in laparoscopic CME and D3 lymphadenectomy for right-sided colon cancer.

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Data availability

The data supporting the findings of this study are available from the corresponding author upon request.

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Funding

This study was funded by the Scientific Research Project of Suining Central Hospital (Granted no. 2019y53).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China

    Wenjun Luo, Fugen Li, Yanling Xiao, Xing Zhang, Liuping Zhang, Meng Sun, Zhengwen Xu & Yingdong Jia

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  1. Wenjun Luo
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  2. Fugen Li
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  3. Yanling Xiao
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  4. Xing Zhang
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  5. Liuping Zhang
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  8. Yingdong Jia
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Contributions

Study conception and design: WL, ZX, and YJ. Acquisition of data: FL, YX, and XZ. Analysis and interpretation of data: LZ and MS. Drafting of manuscript: WL. Critical revision of manuscript: WL and YJ.

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Correspondence to Wenjun Luo.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of Suining Central Hospital, and specimens were taken with the patient’s full consent.

Research involving human participants and/or animals

This study was carried out in accordance with our institutional ethical guidelines and with the 1964 Helsinki Declaration and its later amendments and regarding the involvement of human subjects and the use of human tissues for research.

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Informed consent was obtained from all individual participants included in the study.

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Luo, W., Li, F., Xiao, Y. et al. Laparoscopic right hemicolectomy with complete mesocolic excision plus D3 lymphadenectomy (CME + D3): a new medial approach for central vascular ligation. Updates Surg 74, 117–126 (2022). https://doi.org/10.1007/s13304-021-01144-x

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  • DOI: https://doi.org/10.1007/s13304-021-01144-x

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