VIDEO VIGNETTE
Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation for Right-sided Colon Cancer Using the Retroperitoneal Approach Sung Uk Bae, M.D.1 • Chang-Nam Kim, M.D., Ph.D.2 1 Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea 2 Department of Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
R
ecently, progress in laparoscopic techniques for colorectal cancer surgery has resulted in the development of the medial-to-lateral approach for complete mesocolic excision (CME) and central vascular ligation (CVL) in patients with right-sided colon cancer.1,2 Minimally invasive surgical techniques using the retroperitoneal approach were applied for lymph node dissection in cases of genital carcinoma, nephrectomy, and adrenalectomy and for the resection of retroperitoneal tumors.3–5 The retroperitoneal approach for right-sided CME and CVL for colon cancer is similar to the lateral or inferior approach in that the dissection around the main vessels is performed after retroperitoneal structures are dissected, such as the ureter, gonadal vessels, and duodenum. Some of the advantages as compared with the transabdominal approach include the following: 1) easy identification and dissection of the ureter and the gonadal vessels, 2) creation of most of the retroperitoneal cavity by inserting air through the distension balloon, 3) no disturbance of the surgical field by the small bowel, and 4) less range of the dissection required for the medial-to-lateral transabdominal approach. This video vignette (see Video,
S upplemental Digital Content 1, http://links.lww.com/ DCR/A187) demonstrates the technique and approach for performing a CME and CVL using the retroperitoneal approach in a patient having right-sided colon cancer. In our institute, this approach is commonly performed in a right colectomy for right-sided colon cancer except for tumors >6 cm, tumors locally invading adjacent organs, and perforated or obstructed colon cancer. Thorough knowledge of the retroperitoneal anatomy and advanced surgical techniques enable this approach to be performed easily for right-sided colon cancer, with a minimal risk of injury to the retroperitoneal organs. KEY WORDS: Colonic neoplasms; Laparoscopy; Retroperitoneal space.
ACKNOWLEDGMENT The authors thank Min Hyuk Park for outstanding video narration in generating the high-quality movies. REFERENCES
Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com). Financial Disclosure: None reported. Video display at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, MO, June 2 to 6, 2007. Correspondence: Chang-Nam Kim, M.D., Ph.D., Department of Surgery, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302–799 Korea. E-mail: kimcn7@ gmail.com Dis Colon Rectum 2015; 58: 816 DOI: 10.1097/DCR.0000000000000408 © The ASCRS 2015
816
1. Bae SU, Saklani AP, Lim DR, et al. Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol. 2014;21:2288–2294. 2. Liang JT, Lai HS, Huang J, Sun CT. Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes. Surg Endosc. In press. 3. Hoznek A, Salomon L, Antiphon P, et al. Partial nephrectomy with retroperitoneal laparoscopy. J Urol. 1999;162:1922–1926. 4. Rubinstein M, Gill IS, Aron M, et al. Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol. 2005;174:442–445. 5. Bae SU, Kim CN, Kim KH, et al. Laparoscopic treatment of early retroperitoneal abdominal pregnancy implanted on inferior vena cava. Surg Laparosc Endosc Percutan Tech. 2009;19:e156–e158. Diseases of the Colon & Rectum Volume 58: 8 (2015)
Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited.
Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation for Right-sided Colon Cancer Using the Retroperitoneal Approach Sung Uk Bae, M.D.1 • Chang-Nam Kim, M.D., Ph.D.2 1 Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea 2 Department of Surgery, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
R
ecently, progress in laparoscopic techniques for colorectal cancer surgery has resulted in the development of the medial-to-lateral approach for complete mesocolic excision (CME) and central vascular ligation (CVL) in patients with right-sided colon cancer.1,2 Minimally invasive surgical techniques using the retroperitoneal approach were applied for lymph node dissection in cases of genital carcinoma, nephrectomy, and adrenalectomy and for the resection of retroperitoneal tumors.3–5 The retroperitoneal approach for right-sided CME and CVL for colon cancer is similar to the lateral or inferior approach in that the dissection around the main vessels is performed after retroperitoneal structures are dissected, such as the ureter, gonadal vessels, and duodenum. Some of the advantages as compared with the transabdominal approach include the following: 1) easy identification and dissection of the ureter and the gonadal vessels, 2) creation of most of the retroperitoneal cavity by inserting air through the distension balloon, 3) no disturbance of the surgical field by the small bowel, and 4) less range of the dissection required for the medial-to-lateral transabdominal approach. This video vignette (see Video,
S upplemental Digital Content 1, http://links.lww.com/ DCR/A187) demonstrates the technique and approach for performing a CME and CVL using the retroperitoneal approach in a patient having right-sided colon cancer. In our institute, this approach is commonly performed in a right colectomy for right-sided colon cancer except for tumors >6 cm, tumors locally invading adjacent organs, and perforated or obstructed colon cancer. Thorough knowledge of the retroperitoneal anatomy and advanced surgical techniques enable this approach to be performed easily for right-sided colon cancer, with a minimal risk of injury to the retroperitoneal organs. KEY WORDS: Colonic neoplasms; Laparoscopy; Retroperitoneal space.
ACKNOWLEDGMENT The authors thank Min Hyuk Park for outstanding video narration in generating the high-quality movies. REFERENCES
Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com). Financial Disclosure: None reported. Video display at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, MO, June 2 to 6, 2007. Correspondence: Chang-Nam Kim, M.D., Ph.D., Department of Surgery, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 302–799 Korea. E-mail: kimcn7@ gmail.com Dis Colon Rectum 2015; 58: 816 DOI: 10.1097/DCR.0000000000000408 © The ASCRS 2015
816
1. Bae SU, Saklani AP, Lim DR, et al. Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol. 2014;21:2288–2294. 2. Liang JT, Lai HS, Huang J, Sun CT. Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes. Surg Endosc. In press. 3. Hoznek A, Salomon L, Antiphon P, et al. Partial nephrectomy with retroperitoneal laparoscopy. J Urol. 1999;162:1922–1926. 4. Rubinstein M, Gill IS, Aron M, et al. Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol. 2005;174:442–445. 5. Bae SU, Kim CN, Kim KH, et al. Laparoscopic treatment of early retroperitoneal abdominal pregnancy implanted on inferior vena cava. Surg Laparosc Endosc Percutan Tech. 2009;19:e156–e158. Diseases of the Colon & Rectum Volume 58: 8 (2015)
Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited.
