Cranial approach priority, counterclockwise sequential comple mesocolic excision in laparoscopic right hemicolectomy / 中华内分泌外科杂志

Objective:To analyze the efficacy and safety of cranial approach priority, counterclockwise sequential comple mesocolic excision in laparoscopic right hemicolectomy.Methods:From Jan. 2020 to Dec. 2020, 30 patients with right colon cancer in Department of Gastrointestinal Surgery were retrospectively analyzed. Laparoscopic radical right hemicolectomy was performed via the approach of complete mesocolic excision. The general clinicopathological data of the patients, perioperative data such as operation time, intraoperative blood loss, number of cases of hemorrhage caused by Henle trunk and subordinate branch injury, whether or not converted to open surgery, postoperative pathological data (TNM staging, total number of dissected lymph nodes and the number of metastatic lymph nodes) , postoperative recovery (exhaust time, the time of fluid intake, drainage tube removal and hospital stay) , and complications (such as bleeding, anastomotic leakage, secondary surgery, lymphatic leakage, pulmonary infection, abdominal infection, incision infection, etc) were recorded. Follow-up was performed by telephone or outpatient in 1 year after surgery.Results:The total operation time was (197.80±31.20) minutes, ranging from 150 to 275 minutes, and the intraoperative blood loss was (58.33±30.30) ml, ranging from 10 to 100 ml. There were no cases of intraoperative Henle stem and branch injury bleeding or conversion to open surgery. Postoperative exhaust time was (2.97±0.67) d, ranging from 2 to 4d; postoperative fluid intake time was (3.67±0.76) d, ranging from 3 to 5d; postoperative drainage tube removal time was (6.60±4.00) d, ranging from 4 to 25 days; postoperative hospital stay was (7.87±3.94) days, ranging from 5 to 26 days. pTNM staging: 9 cases of stage I, 5 cases of stage IIA, 1 case of stage IIB, 6 cases of stage IIIA, 4 cases of stage IIIB, and 5 cases of stage IIIC. The total number of lymph nodes dissected was (29.50±8.18) , ranging from 19 to 51; the number of metastatic lymph nodes was (1.40±1.77) , ranging from 0 to 6. Postoperative complications included incision infection in 1 case, anastomotic leakage in 1 case, lymphatic leakage in 2 cases, and lung infection in 1 case. No tumor recurrence or metastasis was found during follow-up, and no patient died.Conclusion:Cranial approach priority, counterclockwise sequential complete mesocolic excision is safe and effective in laparoscopic right hemicolectomy.

Initial experience of laparoscopic right hemicolectomy with complete mesocolic excision in Singapore: a case series

INTRODUCTION@#Laparoscopic colorectal surgery is increasingly performed worldwide due to its multiple advantages over traditional open surgery. In the surgical treatment of right-sided colonic tumours, the latest technique is laparoscopic right hemicolectomy with complete mesocolic excision (lapCME), which aims to lower the rate of local recurrence and maximise survival as compared to standard laparoscopic right hemicolectomy (lapS).@*METHODS@#We conducted a retrospective analysis of our initial experience with lapCME in Singapore General Hospital between 2012 and 2015. All procedures were performed by a single surgeon.@*RESULTS@#Nine patients underwent lapCME and 16 patients underwent lapS. Indication for lapCME was cancer in the right colon. None of the patients required conversion to open surgery, and all were discharged well. The number of lymph nodes resected in the lapCME group was significantly greater than in the lapS group (29 ± 15 vs. 19 ± 6; p = 0.02) during the study period, and the mean operation time was significantly longer for lapCME (237 ± 50 minutes vs. 156 ± 46 minutes; p = 0.0005). There were no statistically significant differences in terms of demographics, tumour stage, time taken for bowel to open postoperatively, time taken for patient to resume a solid diet postoperatively and length of hospital stay. Two patients who underwent lapS were re-admitted for intra-abdominal collections - one patient required radiology-guided drainage, while the other patient was managed conservatively.@*CONCLUSION@#Our initial experience with lapCME confirms the feasibility and safety of the procedure.

Comparison of the short-term efficacy of modified intermediate approach and traditional intermediate approach in laparoscopic radical right hemicolectomy / 中国综合临床

Objective To compare and analyze the short-term efficacy of modified intermediate laparoscopic right hemicolectomy (LRHC) and traditional intermediate laparoscopic right hemicolectomy (LRHC) in patients with colon cancer.Methods Eighty-four patients with colon cancer treated by laparoscopic right hemicolectomy (LRHC) from March 2014 to March 2018 in the General Surgery department of Guangzhou Hospital of Traditional Chinese Medicine were randomly divided into two groups.The control group was treated with traditional intermediate approach,while the improved group was treated with improved intermediate approach centering on the anterior pancreatic head region,with 42 cases in each group.The two groups of operations and related complications were statistically analyzed and compared.Results Compared to the control group,the improved group had less estimated mean blood loss ((39.5± 11.6) ml vs.(86.3± 13.7) ml,t =11.124,P＜0.05),shorter operative time((104.5±20.5) min vs.(139.3±25.9) min,t =6.094,P＜0.05) and lower intraoperative vascular damage rate (7.1％ (3/42) vs.23.8％ (10/42),x2=7.406,P＜0.05).There were no significant differences in the number of conversion to laparotomy,number of harvested lymph node,postoperative complications,hospital stay and quality of postoperative specimens between the two groups (P＞ 0.05).Conclusion Modified intermediate approach LRHC for colon cancer patients not only reduces the amount of bleeding and operation time,but also significantly reduces the rate of intraoperative vascular injury.

Anatomical observation of complete mesocolic excision during laparoscopic right hemicolectomy / 局解手术学杂志

Objective To explore regional anatomical features of fascia and spaces related to complete mesocolic excision (CME)dur-ing laparoscopic right hemicolectomy.Methods Observe and describe the regional anatomical features of related mesenterium,fascia and spaces through autopsy and somatoscopy.Results Superior mesenteric vein is the anatomic landmark in CME with medial access for laparo-scopic right hemicolectomy.Right mesocolon and ileal mesentery are the main mesenterium,and the fascia contains the prerenal fascia and the pancreatic fascia.The right retrocolic space and the colon transversum space are two important anatomical spaces,and their fusion fascia space served as a natural surgical plane.Conclusion There is a natural surgical plane which made of mesenterium,fascia and spaces be-tween mesocolon and prerenal fascia in CME during laparoscopic right hemicolectomy,and the surgery is feasible.