A modified combined approach in laparoscopic right hemicolectomy for right-sided colon based on surgical trunk orientation: a case of a new surgical technique

Abstract

Colorectal cancer remains a significant threat to human life and health, with Laparoscopic technology represents a pivotal advancement in its treatment. Laparoscopic right hemicolectomy has emerged as the preferred surgical modality for managing right-sided colon cancer, offering minimally invasive benefits and expedited recovery. However, the right colon anatomy, characterized by complex vascular branching patterns and frequent variations, presents significant surgical challenges. Various surgical access methods have been proposed to address these challenges, each with distinct advantages and limitations. To optimize surgical outcomes, our research team has meticulously analyzed these approaches and developed a modified combined approach for laparoscopic right hemicolectomy in the treatment of right-sided colon cancer. This innovative approach integrates the strengths of different methods to enhance surgical efficacy while minimizing intraoperative bleeding, facilitating rapid recovery, and ensuring favorable prognosis. We report a case of a 76-year-old male with hypertension who presented with rectal bleeding. Preoperative evaluation revealed moderately differentiated adenocarcinoma in the ascending colon (clinical stage T3N1bM0). The patient underwent the modified combined approach of laparoscopic right hemicolectomy. The surgery was successful, with few intraoperative complications. Postoperatively, the patient had an uneventful recovery, was discharged after 8 days, and showed no signs of recurrence at 6-month follow-up. We anticipate that this novel surgical approach will provide more precise and efficient treatment options, ultimately improving the overall quality of life for patients with right-sided colon cancer.

Keywords: Combined approach; laparoscopy; right-sided colon cancer; surgical technique; surgical trunk orientation.

Figure 1

Preoperative biopsy pathology results and imaging findings. (A) Colonoscopy biopsy specimen. (B) Pathologic image of the colonoscopy biopsy specimen (hematoxylin and eosin staining). (C) Preoperative CT cross-section of the lesion. (D) Coronal view of the preoperative CT lesion. CT, computed tomography.

Video 1

A modified combined approach in laparoscopic right hemicolectomy for right-sided colon based on surgical trunk orientation.

Figure 2

Postoperative gross specimens and pathologic findings. (A) Postoperative tumor specimen and (B) pathological image of the postoperative tumor specimen (hematoxylin and eosin staining).