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. 2022 Jul-Sep;18(3):391-395.
doi: 10.4103/jmas.JMAS_282_20.

Initial retrocolic endoscopic tunnel approach: A promising technique for radical right hemicolectomy

Monika Gureh  1 , Sanjay Gupta  1 , Ashok K Attri  1
Affiliations

Initial retrocolic endoscopic tunnel approach: A promising technique for radical right hemicolectomy

Monika Gureh et al. J Minim Access Surg. 2022 Jul-Sep.

Abstract

Background: Complete mesocolic excision with central vascular ligation for colonic cancers improves overall survival. To achieve better short term and oncological results, different laparoscopic techniques have been described for right-sided colonic cancers. Laparoscopic right hemicolectomy by the Initial Retrocolic Endoscopic Tunnel Approach (IRETA) is proposed to be easy and offer desired oncological resection; we present our results with IRETA.

Patients and methods: The data of all patients who underwent right hemicolectomy by IRETA for colonic cancer between January 2019 and March 2020 were retrospectively analysed for demographics, clinical features, oncological completeness of resected specimen, complications, hospital stay, morbidity and mortality.

Results: A total of eight patients (05 males and 03 females) were identified. The mean operating time was 190 ± 32.40 minutes. Margins of all resected specimens were free of tumour except for one in which retro-peritoneal circumferential resection margin was positive. On average 13.75 ± 2.63 lymph nodes were retrieved. Except for wound infection in one patient, no other morbidity was seen.

Conclusion: Laparoscopic radical right hemicolectomy by IRETA is safe and gives desired oncological results.

Keywords: Complete mesocolic excision; laparoscopy; retrocolic tunneling; right hemicolectomy.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Port position
Figure 2
Figure 2
Cranial traction on mesentry of small bowel to expose caecal peritoneal reflection and root of mesentary upto duodenojejunal flexure
Figure 3
Figure 3
Opening the avascular plane between Toldt's fascia below and mesocolic fascia above to form retrocolic tunnel
Figure 4
Figure 4
Extent of retrocolic dissection (D1D2-first and second part of duodenum)
Figure 5
Figure 5
Dissection of ileocolic pedicle till its junction with superior mesenteric vein
Figure 6
Figure 6
Clipped and divided right colic and middle colic vessels at their origin (RCA: Right colic artery, rMCA: Right branch of middle colic artery, MCV: Middle colic vein)
See this image and copyright information in PMC

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