Step-by-step bottom-up laparoscopic right hemicolectomy with complete mesocolic excision: a technical video demonstration.

BACKGROUND

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.

TECHNIQUE

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.

CONCLUSION

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.