Laparoscopic right hemicolectomy with caudo-cranial dissection. Original tecnique and results of first 70 consecutive cases.

Laparoscopic right hemicolectomy (LRH) is usually performed by a medial to lateral technique. Difficulties are represented by identification of the correct dissection plane. The 3rd part of the duodenum, an important landmark, in not easily identified in fat pts while in slim pts the mesentery of the right flexure is thin and fragile. Methods: We have developed a technique of caudo-cranial dissection: (1) Identification and section of the ileo-colic vessels at their origin. (2) Division of mesentery up to the terminal ileum, which is cutted by EndoGIA stapler. (3) Incision of the Houston’s legament. (4) Retroperitoneal dissection of the cecum and ascending colon up to the right flexure by pulling upwards the terminal ileum. (5) Incision of hepato-duodeno-colic legament. (6) Cranial traction of the specimen to identify and cut the right colic vessels and Henle’s venous branch. In fat patients, section of the ileocolics vessels can be performed after preparation of the retroperitoneum up to the third part of the duodenum. Results: This technique has been used in 70 pts: 38 men and 32 women. Mean age: 68.3 yrs and a mean BMI of 25.6 (22.3–37.4); the average time of operation was 125 min, with no conversions. Mean postoperative hospital stay was 5.3 days. Two pts have an anastomotic leak.