Picciariello Arcangelo, Corcione Francesco, Delrio Paolo, Ruotolo Francesco, Vincenti Leonardo
Department of Experimental Medicine, University of Salento, Lecce, Italy.
General Surgery Unit, IRCCS "Saverio De Bellis", Castellana Grotte, Italy.
Surg Endosc. 2025 Jul 9. doi: 10.1007/s00464-025-11973-1.
Laparoscopic right hemicolectomy with complete mesocolic excision (CME) ensures an oncologically sound resection and aims to optimize long-term outcomes. The D2 and D3 lymphadenectomy techniques remain controversial, with unclear additional benefits from extended lymphadenectomy. This procedure's complexity is heightened by significant vascular variability. We describe the bottom-up approach for laparoscopic right hemicolectomy with CME.
The patient is positioned in lithotomy, and trocars are placed in the suprapubic region. The peritoneum is incised near the ileocaecal junction, and the terminal ileum is lifted following the avascular plane. The mesocolon is separated from the duodenum, and vascular structures such as the ileocolic artery and vein are identified and ligated. The dissection continues around the superior mesenteric vein, the Henle's trunk, the middle colic vein, and transverse mesocolon. The transverse colon is transected distally. An intracorporeal side-to-side anastomosis is performed. The specimen is extracted via a mini-Pfannenstiel incision.
The bottom-up approach could allow precise dissection and oncologically sound resection while potentially minimizing the risk of vascular injury. The mesocolon is preserved intact, and the "en bloc" resection of the tumor and mesentery is performed safely.
腹腔镜右半结肠切除术联合完整结肠系膜切除术（CME）可确保肿瘤学上合理的切除，并旨在优化长期预后。D2和D3淋巴结清扫技术仍存在争议，扩大淋巴结清扫的额外益处尚不清楚。该手术的复杂性因显著的血管变异而增加。我们描述了腹腔镜右半结肠切除术联合CME的自下而上方法。
患者取截石位，在耻骨上区域置入套管针。在回盲部附近切开腹膜，沿无血管平面提起回肠末端。将结肠系膜与十二指肠分离，识别并结扎回结肠动静脉等血管结构。围绕肠系膜上静脉、亨氏干、结肠中静脉和横结肠系膜继续进行解剖。在远端横断横结肠。进行体内侧侧吻合。通过迷你Pfannenstiel切口取出标本。
自下而上方法可实现精确解剖和肿瘤学上合理的切除，同时可能将血管损伤风险降至最低。结肠系膜保持完整，肿瘤和系膜的“整块”切除得以安全进行。
