Unidirectionally proceding and pancreas-oriented procedure for laparoscopic radical right hemicolectomy with D3 lymphadenectomy

Abstract

Objective To facilitate laparoscopic D3/CME right hemicolectomy, here we introduce an unidirectionally proceding and pancreas-oriented procedure for laparoscopic radical right hemicolectomy with D3 lymphadenectomy. Methods This novel approach of D3 hemicolectomy is characterized by the following two features: series of repeated unidirctionally preceding dissection along SMV starting caudally and ending at the lower edge of pancreatic neck, and identifying the left 1/3 aspect of the whole length of SMV firstly followed by ligation of individual colonic veins. From Jan 2012 to Dec 2015, 58 patients but 2 underwent this procedure successfully. Results The operation time was 164±28.3 min, blood loss was 64±63.5 ml, retrieved lymph nodes were 28±13.9, no mortality and major mobidity were observed. Conclusions This novel unidirectionally proceding and pancreas-oriented procedure for laparoscopic radical right hemicolectomy with D3 lymphadenectomy is safe and feasible, with the merit of providing an easier and safer way of managing the frequent variations of tributaries of SMV. Key words: Colonic neoplasms; Laparoscopes; D3 lymphadenectomy; Complete mesocolon excision