"CAUDAL-TO-CRANIAL" PLUS "ARTERY FIRST TECHNIQUE" WITH BEYOND D3 LYMPH NODE DISSECTION ON LAPAROSCOPIC RIGHT HEMICOLECTOMY
Beishi Zheng*1, Yichen Wang2, Liaonan Zou3
1Internal Medicine, Woodhull Medical Center, Brooklyn, NY; 2Trinity Health Of New England Medical Group Agawam Office Silver Street, Agawam, MA; 3The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
As laparoscopic right colectomy is relatively complex, a uniform standard operation is not yet available. Here, we present a "caudal-to-cranial" plus "artery first" technique with beyond D3 lymph node dissection and described the entire procedure along with some critical surgical points. The pivotal step is to cut the "white-yellow" line to enter the Toldt's space and expose the dorsal side of mesocolon and the superior mesenteric vessels. With the caudal to cranial technique, it is very easy to enter and explore the proper plane by following the fine areolar tissue. This may help decrease the potential injuries to retroperitoneal structures, such as ureter, pancreas and gonadal vessels.
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