Çapkınoğlu Emir, Arıkan Akif Enes, Dülgeroğlu Onur, Uras Cihan
Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
Wideochir Inne Tech Maloinwazyjne. 2022 Dec;17(4):699-704. doi: 10.5114/wiitm.2022.118683. Epub 2022 Aug 10.
A mesocolic plane, central vascular ligation (CVL) and proper proximal-distal margins are the essential components of complete mesocolic excision (CME). In the transmesocolic approach, we identify the middle colic vessels and enter the lesser sac through the mesocolon for ascending colon and caecum tumors.
To investigate the feasibility and identify the technical details of this technique.
The clinical and pathological findings of 26 patients who had undergone laparoscopic right hemicolectomy with CME between 2010 and 2020 were collected retrospectively. All operation videos were recorded and reviewed by the authors with regard to the components of CME. In the transmesocolic approach, dissection starts with identification of the middle colic vessels directly. After division of the middle colic vessels, we enter the omental bursa and dissection continues from superior to inferior direction.
There were 26 patients in the study. The mean age was 59.3 ±16.1. There were 15 female and 11 male patients with a mean body mass index of 25.9 ±16.1 kg/m. The mean operative time was 137.6 ±19.4 min. The mean length of hospital stay and the time to first flatus were 7.5 ±4.6 days and 2.3 ±1.5 days, respectively. None of the patients were re-admitted to the hospital in 30 days. There was no 30-day mortality in the patients. There were no major complications.
The transmesocolic approach seems to be feasible and safe for CME in right sided colon cancers. However, more prospective randomized studies are needed to use the transmesocolic approach as a standard technique.
结肠系膜平面、中央血管结扎（CVL）以及合适的近端-远端切缘是完整结肠系膜切除术（CME）的关键组成部分。在经结肠系膜入路中，我们识别中结肠血管，并通过结肠系膜进入小网膜囊以处理升结肠和盲肠肿瘤。
探讨该技术的可行性并确定其技术细节。
回顾性收集2010年至2020年间接受腹腔镜右半结肠切除术并采用CME的26例患者的临床和病理资料。作者对所有手术视频进行记录并就CME的组成部分进行回顾。在经结肠系膜入路中，直接从识别中结肠血管开始进行解剖。在离断中结肠血管后，我们进入网膜囊并从上方至下方继续解剖。
本研究共26例患者。平均年龄为59.3±16.1岁。有15例女性和11例男性患者，平均体重指数为25.9±16.1kg/m。平均手术时间为137.6±19.4分钟。平均住院时间和首次排气时间分别为7.5±4.6天和2.3±1.5天。所有患者均未在30天内再次入院。患者无30天死亡率。无严重并发症。
经结肠系膜入路对于右侧结肠癌的CME似乎是可行且安全的。然而，需要更多前瞻性随机研究以将经结肠系膜入路作为标准技术应用。
