Surgical Emergency Unit, Department of General Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford (UK).
Department of General Surgery, University of Insubria, Varese, Italy.
Surg Technol Int. 2021 Nov 4;39:173-175. doi: 10.52198/21.STI.39.CR1511.
Laparoscopic right hemicolectomy requires a precise anatomical dissection to mobilise the right and proximal transverse mesocolon, following the avascular fusion planes of Toldt and Fredet. Fredet's plane is crucial to the preparation of the origin of vessels. Easy access to Fredet's and Toldt's fasciae can be obtained through the "duodenal window", a flimsy area of the root of the proximal transverse mesocolon, the margins of which are the right border of the superior mesenteric pedicle, the ileocolic pedicle, the right colic pedicle and the marginal artery.
We propose that dissection of the duodenal window should be the first step in laparoscopic right hemicolectomy, to obtain easy access to the duodenopancreatic plane and prepare the fascia.
This "duodenal window-first" technique has been applied in 45 laparoscopic right hemicolectomies and 14 laparoscopic extended right hemicolectomies, with only two conversions to open surgery. The duodenal window was easily identified in all but 3 cases with significant visceral obesity. No significant intra- or postoperative morbidity was recorded in these cases and the median postoperative length of stay was 4 days. All resections were R0 and an adequate number of retrieved lymph nodes were obtained in almost all cases.
The duodenal window-first approach is a feasible and safe technique to standardise the first steps of radical laparoscopic right hemicolectomy, allowing prompt and complete anatomical identification and dissection.
腹腔镜右半结肠切除术需要精确的解剖分离，以游离右半和近端横结肠系膜，遵循 Toldt 和 Fredet 的无血管融合平面。Fredet 平面对于血管起源的准备至关重要。通过“十二指肠窗”可以轻松进入 Fredet 和 Toldt 筋膜，十二指肠窗是近端横结肠系膜根部的一个脆弱区域，其边缘为肠系膜上动脉右侧缘、回结肠蒂、右结肠蒂和边缘动脉。
我们建议在腹腔镜右半结肠切除术中首先进行十二指肠窗解剖，以方便进入十二指肠胰腺平面并准备筋膜。
这种“十二指肠窗首先”的技术已应用于 45 例腹腔镜右半结肠切除术和 14 例腹腔镜扩大右半结肠切除术，仅 2 例转为开腹手术。除了 3 例有明显内脏肥胖的病例外，所有病例均能轻松识别十二指肠窗。这些病例均无明显的术中或术后并发症，术后中位住院时间为 4 天。所有切除均为 R0，且在几乎所有病例中均获得了足够数量的淋巴结。
十二指肠窗首先的方法是一种可行且安全的技术，可以规范腹腔镜右半结肠切除术的最初步骤，实现快速和完整的解剖识别和分离。
