Laparoscopic Right Hemicolectomy with an Inferior Approach: How I Do It

Abstract

Since its introduction in the early 1990s, laparoscopic colorectal surgery has been extensively validated through randomized controlled trials, establishing its safety and efficacy from oncological and technical standpoints. Laparoscopic right hemicolectomy (LRHC) procedures exhibit variability in dissection extent and initiation sites. Complete mesocolic excision is essential in LRHC, involving precise dissection along embryologic planes and varying in lymph node dissection extent (D2 or D3). Other variations in LRHC include the use of the medial approach (or superior mesenteric vein [SMV]-first approach), where dissection starts along the SMV, the lateral approach (or inferior approach), starting with meso-ileal and retroperitoneal dissection, and the superior approach, initiated by separation of the omentum and transverse colon. This paper presents a case of LRHC for ascending colon cancer using an inferior approach. The procedure included trocar placement, followed by inferior, superior, and medial dissection phases, concluding with specimen extraction and extracorporeal anastomosis. With a standardized procedure, mastery of diverse approaches (inferior, medial, and superior) remains crucial, as the most appropriate method varies among cases.