Laparoscopic Medial-to-Lateral Approach for the Curative Left Hemicolectomy

Abstract

Laparcoscopic curative left hemicolectomy requires the takedown of colonic splenic flexure and has been challenging. The present study aims to examine if the technical advantages of medial-to-lateral dissection method, as shown in our previous laparoscopic rectosigmoid resection, can be extrapolated to the laparoscopic left hemicolectomy. A total of 24 consecutive patients (from October 2004 to March 2005) with left-sided colon cancer requiring the takedown of colonic splenic flexure to facilitate a curative left hemicolectomy were subjected to this laparoscopic procedure that included initial incision on the mesentery medial to inferior mesenteric vein, ligation of vessels in no-touch isolation fashion, subsequent medial-to-lateral extension of retroperitoneal dissection along Gerota fascia, opening of lesser sac by transection of gastrocolic ligament, dissection of mesenteric root of distal transverse colon, and the final separation of splenocolic ligament and lateral attachments of descending colon. The technical efficiency, the number of cleared lymph node, and functional recovery of patients were prospectively evaluated. The laparoscopic medial-to-lateral approach is considered as highly efficient because it was preformed with acceptable operation time (214.4 ± 54.4 minutes, mean±standard deviation) and little blood loss (40.0 ± 14.0 ml) through a small wound (5.5 ± 0.6 cm). The number of dissected lymph nodes was 14.0 ± 3.0. There were no major complications. Moderate morbidity represented 8 percent of all cases, including minor leakage in 1 case (4 percent) and wound infection in 1 case (4 percent). The patients have quick functional recovery, as evaluated by the length of postoperative ileus (48.0 ± 12.0 hours), hospitalization (9.0 ± 1.0 days), and degree of postoperative pain (3.5 ± 0.5, visual analog scale). The overall costs were NT$194,000.0 ± 3200.0 (1.0 US dollar = 32.0 NT$). By medial-to-lateral dissection method, the laparoscopic takedown of colonic splenic flexure can be performed with highly technical efficiency, acceptable number of cleared lymph node, and short convalescence. We therefore recommend this dissection method to the expert surgeons, endeavoring to define a standard technique to curative surgery in the left-sided colon cancers, and especially to the beginners, seeking to shorten their learning curve of laparoscopic left hemicolectomy.