Abstract
Background
Proper identification of the mesocolic vessels is essential for achieving complete mesocolic excision (CME) in cases of colon cancer requiring an extended right hemicolectomy. In robotic procedures, we employed a “top down technique” to allow early identification of the gastrocolic trunk and middle colic vessels. The aim of our study was to illustrate the details of this technique in a series of 12 patients.
Methods
The top down technique consists of two steps. First, the omental bursa was entered to identify the right gastroepiploic vein. Tracing down this vein as a landmark, the gastrocolic trunk was exposed, branches of this trunk and the middle colic vessels were divided. Second, dissection was directed to the ileocolic region and proceeded in an inferior-to-superior direction along the superior mesenteric vein to divide the ileocolic and right colic vessels consecutively. The ileotranverse anastomosis was created intracorporeally.
Results
There were 8 males and 4 females with a mean age of 64.8 ± 16.9 years and a mean body mass index of 25.6 ± 3.7 kg/m2. All the procedures were completed successfully. No conversions occurred. The mean operative time and blood loss were 312.1 ± 93.9 min and 110.0 ± 89.9 ml, respectively. The mean number of harvested lymph nodes was 45.2 ± 11.1. The mean length of hospital stay was 7.6 ± 4.7 days. Two patients had intraoperative complications and two had postoperative complications. There was no disease recurrence at a mean follow-up period of 10.4 ± 7.1 months.
Conclusions
The top down technique appears to be useful in robotic CME for an extended right hemicolectomy. Early identification of the gastrocolic trunk and middle colic vessels via this technique may prevent inadvertent vascular injury at the mesenteric root of the transverse colon.
References
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis 11:354–364
West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28:272–278
Søndenaa K, Quirke P, Kennedy RH et al (2014) The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: proceedings of a consensus conference. Int J Colorectal Dis 29:419–428
Siani LM, Pulica C (2015) Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: Long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery. Scand J Surg 104:219–226
Mori S, Baba K, Yanagi M et al (2015) Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk for right colon cancer. Surg Endosc 29:34–40
Uematsu D, Akiyama G, Sugihara T, Magishi A, Yamaguchi T, Sano T (2017) Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure. Asian J Endosc Surg 10:23–27
Trastulli S, Desiderio J, Farinacci F et al (2013) Robotic right colectomy for cancer with intracorporeal anastomosis: short-term outcomes from a single institution. Int J Colorectal Dis 28:807–814
Ozben V, Baca B, Atasoy D et al (2016) Robotic complete mesocolic excision for right-sided colon cancer. Surg Endosc 30:4624–4625
Cho MS, Baek SJ, Hur H, Min BS, Baik SH, Kim NK (2015) Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg 261:708–715
Li H, He Y, Lin Z et al (2016) Laparoscopic caudal-to-cranial approach for radical lymph node dissection in right hemicolectomy. Langenbecks Arch Surg 401:741–746
Ignjatovic D, Stimec B, Finjord T, Bergamaschi R (2004) Venous anatomy of the right colon: three-dimensional topographic mapping of the gastrocolic trunk of Henle. Tech Coloproctol 8:19–21
Matsuda T, Iwasaki T, Mitsutsuji M et al (2015) Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy. Surg Endosc 29:1001
Matsuda T, Iwasaki T, Sumi Y et al (2017) Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach: anatomical and embryological consideration. Int J Colorectal Dis 32:139–141
Benlice C, Baca B, Firidin SN, Muti A, Aytac E, Erguner I, Erdamar S, Senocak M, Turna H, Hamzaoglu I, Karahasanoglu T (2016) Increased caseload volume is associated with better oncologic outcomes after laparoscopic resections for colorectal cancer. Surg Laparosc Endosc Percutan Tech 26:49–53
Turnbull RB Jr, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg 166:420–427
Rosenberg J, Fischer A, Haglind E, Scandinavian Surgical Outcomes Research Group (2012) Current controversies in colorectal surgery: the way to resolve uncertainty and move forward. Colorectal Dis 14:266–269
Killeen S, Mannion M, Devaney A, Winter DC (2014) Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Colorectal Dis 16:577–594
Fujita J, Uyama I, Sugioka A, Komori Y, Matsui H, Hasumi A (2001) Laparoscopic right hemicolectomy with radical lymph node dissection using the no-touch isolation technique for advanced colon cancer. Surg Today 31:93–96
Benz S, Tam Y, Tannapfel A, Stricker I (2016) The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc 30:1930–1937
Koh FH, Tan KK (2016) A safe method for middle colic dissection and ligation at its origin in a laparoscopic extended right hemicolectomy. Ann Surg Oncol 23(Suppl 5):665
Zou L, Xiong W, Mo D et al (2016) Laparoscopic radical extended right hemicolectomy using a caudal-to-cranial approach. Ann Surg Oncol 23:2562–2563
Formisano G, Misitano P, Giuliani G, Calamati G, Salvischiani L, Bianchi PP (2016) Laparoscopic versus robotic right colectomy: technique and outcomes. Updates Surg 68:63–69
Mathew R, Kim SH (2013) Robotic right hemicolectomy with D3 lymphadenectomy and complete mesocolic excision: technical detail. OA Rob Surg 1:6
Zhao LY, Liu H, Wang YN, Deng HJ, Xue Q, Li GX (2014) Techniques and feasibility of laparoscopic extended right hemicolectomy with D3 lymphadenectomy. World J Gastroenterol 20:10531–10536
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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.
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Hamzaoglu, I., Ozben, V., Sapci, I. et al. “Top down no-touch” technique in robotic complete mesocolic excision for extended right hemicolectomy with intracorporeal anastomosis. Tech Coloproctol 22, 607–611 (2018). https://doi.org/10.1007/s10151-018-1831-0
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DOI: https://doi.org/10.1007/s10151-018-1831-0