Transmesocolic approach in laparoscopic complete mesocolic excision for right sided colon cancers

Introduction
A mesocolic plane, central vascular ligation (CVL) and proper proximal-distal margins are the essential components of complete mesocolic excision (CME). In the transmesocolic approach, we identify the middle colic vessels and enter the lesser sac through the mesocolon for ascending colon and caecum tumors.

Aim
To investigate the feasibility and identify the technical details of this technique.

Material and methods
The clinical and pathological findings of 26 patients who had undergone laparoscopic right hemicolectomy with CME between 2010 and 2020 were collected retrospectively. All operation videos were recorded and reviewed by the authors with regard to the components of CME. In the transmesocolic approach, dissection starts with identification of the middle colic vessels directly. After division of the middle colic vessels, we enter the omental bursa and dissection continues from superior to inferior direction.

Results
There were 26 patients in the study. The mean age was 59.3 ±16.1. There were 15 female and 11 male patients with a mean body mass index of 25.9 ±16.1 kg/m2. The mean operative time was 137.6 ±19.4 min. The mean length of hospital stay and the time to first flatus were 7.5 ±4.6 days and 2.3 ±1.5 days, respectively. None of the patients were re-admitted to the hospital in 30 days. There was no 30-day mortality in the patients. There were no major complications.

Conclusions
The transmesocolic approach seems to be feasible and safe for CME in right sided colon cancers. However, more prospective randomized studies are needed to use the transmesocolic approach as a standard technique.