Laparoscopic Medial-to-lateral Colon Dissection: How and Why

Abstract

Laparoscopic colectomy is a difficult procedure with a long learning curve. We describe in this study our technique for right- and left-sided laparoscopic medial-to-lateral colectomy. The medial approach involves division of the vascular pedicle first, followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders the dissection fast and safe. Our series of 50 consecutive laparoscopic colectomies supports this concept. We believe that surgeons familiar with this technique will have an important tool in their armamentarium to circumvent some of the challenges of laparoscopic colectomy.

Laparoscopic caudal-to-cranial approach for radical lymph node dissection in right hemicolectomy

“…In open-access surgery, the traditional lateral to medial approach is adopted, that is, the lateral peritoneal attachments are separated first and then the medial side of the mesocolon is explored and the major vessels are ligated at last. While the medial-to-lateral access is performed in laparoscopic surgery, the mesenteric vessels are initially explored and divided and the medial mesenteric base of the colon is dissected, and finally the colonic lateral peritoneal attachments are separated [14][15][16]. BThe uncinate process first approach (UFA)^is a newly reported laparoscopic right hemicolectomy approach [9].…”

“…The lymph nodes are harvested completely in this way, which corresponds to the maximal harvest of the regional lymph nodes and improved survival [17]. In this study, the mean number of harvested lymph nodes is 19 (range, [12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Resultados do registro nacional brasileiro em vídeo-cirurgia colorretal - 2007

“…Essa manobra permite a identificação imediata do plano entre o mesocólon e o retroperitônio, constituindo um tempo operatório rápido que ainda tem a vantagem de preservar os ligamentos laterais do cólon e melhorar a exposição das estruturas retroperitoniais como o ureter 36 . A experiência acumulada e a melhor seleção prévia dos pacientes se refletiram também em uma diminuição importante nas taxas de conversão, que passaram de 10,6% em 2001 para 5,5% em 2007 (variação de 0 a 16,5%).…”

Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization

“…We perform a medial-to-lateral mobilization using the inferior mesenteric vein as the initial landmark, as described previously [6]. The dissection is performed using the first robotic arm connected to monopolar curved scissors and the third robotic arm connected to a fenestrated bipolar grasper.…”