A New Approach to Laparoscopic Lymph Node Excision in Cases of Transverse Colon Cancer

Abstract

Background: Treatment of transverse colon cancer by laparoscopic surgery is difficult, and this surgery has been excluded in many randomized control trials. Difficulty in excising lymph nodes around the middle colonic artery has been the main factor responsible for the complexity of this surgery. Herein, we describe a new approach to overcome this difficulty in lymph node excision in cases of transverse colon cancer. Approach: We adopted the following steps to collect information that was otherwise difficult to obtain from two-dimensional images displayed on the monitor screen, in order to ensure safety during laparoscopic surgery. (1) The omental bursa was opened by directly visualizing it through a small incision created in the median epigastric region, and the cranial side of the transverse colon mesentery was then freed. (2) The colonic drainage vein entering the right gastroepiploic vein was dissected, and a gauze was inserted into the freed layer. (3) Under laparoscopic guidance, the freed layer was fixed, with the inserted gauze serving as a landmark. The lymph nodes were then excised making full use of the horizontal view. Conclusion: Utilization of a small incision in the abdomen enables full use of the horizontal view for manipulations during laparoscopy, allowing safe manipulations for lymph node excision.

Analysis of the Positional Relationship Among the Operator, Camera, and Monitor: Overcoming the Difficulties of Mirror-image Conditions During Laparoscopic Surgery

“…Laparoscopy-assisted colectomy was first reported in 1991, 13 – 15 although it is difficult to perform for transverse colon cancer; therefore, the port location and procedure with respect to transverse colon cancer vary across facilities. 16 , 17 In contrast, the port location and procedure when performing a sigmoidectomy or anterior resection (left-sided colorectal surgery) have now been standardized. 2 , 18 , 19 …”

“…Laparoscopy-assisted colectomy was first reported in 1991, [13][14][15] although it is difficult to perform for transverse colon cancer; therefore, the port location and procedure with respect to transverse colon cancer vary across facilities. 16,17 In contrast, the port location and procedure when performing a sigmoidectomy or anterior resection (left-sided colorectal surgery) have now been standardized. 2,18,19 Therefore, we studied the port position and orientations of the surgical team and monitor when performing general laparoscopic surgery for left-sided colorectal surgery, and showed the benefit of laparoscopic training under mirror-image conditions.…”