Complete Mesocolic Excision with Central Vascular Ligation during Laparoscopic Right Hemicolectomy: Technical Notes

Maria Michela Di Nuzzo, Roberto Peltrini, Luigi Vanni, Michele D’Ambra, Umberto Bracale, Francesco Corcione

In this article we describe the surgical technique of the Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) during laparoscopic right hemicolectomy (LRH) with intracorporeal anastomosis, as performed in our current surgical practice. The preparation of the patient, the operating room, the position of the
surgeons, equipment and trocar placement are described in detail. The procedure is divided into well-defined steps, and each one is meticulously described.

Keywords: minimally invasive, laparoscopic right hemicolectomy, mesocolic excision, central vascular ligation

Full article PDF

1. Gachabayov M, Bendl R, Latifi R, Bergamaschi R. Right Colon Resection: Evolution and Surgical Technique. Surg Technol Int. 2020;37:87-92.
2. Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M,et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050-9.
3. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J. Survival after laparoscopic surgery versus open surgery for colon cancer: longterm outcome of a randomised clinical trial. Lancet Oncol. 2009;10:44-52.
4. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation – technical notes and outcome. Colorectal Dis. 2009;11:354-64.
5. Benz SR, Tannapfel A, Tam Y, Stricker I.Complete Mesocolic Excision for Right-Sided Colon Cancer – The Role of Central Lymph Nodes. Zentralbl Chir. 2015;140:449-52.
6. Peltrini R, D’Ambra M, Bartolini C, Lionetti R, Bracale U, Corcione F. Laparoscopic right hemicolectomy for cT4b caecal adenocarcinoma involving the bladder – a video vignette. Colorectal Dis. 2020;22:1771-1772.
7. Peltrini R, Luglio G, Pagano G, Sacco M, Sollazzo V, Bucci L. Gastrocolic trunk of Henle and its variants: review of the literature and clinical relevance in colectomy for right-sided colon cancer. Surg Radiol Anat. 2019;41:879-887.
8. Bracale U, Merola G, Rizzuto A, Pontecorvi E, Silvestri V, Pignata G,et al. Does a 3D laparoscopic approach improve surgical outcome of mininvasive right colectomy? A retrospective case-control study. Updates Surg. 2020;72:445-451.
9. Pedrazzani C, Conti C, Mantovani G, Fernandes E, Turri G, Lazzarini E. Laparoscopic colorectal surgery and Enhanced Recovery After Surgery (ERAS) program: Experience with 200 cases from a single Italian center. Medicine (Baltimore). 2018;97:e12137.
10. Bracale U, Merola G, Cabras F, Andreuccetti J, Corcione F, Pignata G. The Use of Barbed Suture for Intracorporeal Mechanical Anastomosis During a Totally Laparoscopic Right Colectomy: Is It Safe? A Retrospective Nonrandomized Comparative Multicenter Study. Surg Innov. 2018;25:267-273.