The Initial Retrocolic Endoscopic Tunnel Approach (IRETA) to a Laparoscopic-Assisted Radical Right Colectomy: A (Modified) Lateral-to-Medial Technique for the Complete Mesocolic Excision of the Right Colon

Abstract

Cancer of the colon is a highly treatable and often curable disease when localised to bowel, where cure in about 50–70% of patients can be expected. Radical resection of the tumour, that is, a complete mesocolic excision (CME) denoting resection of the tumour-bearing segment of colon and a systematic lymphadenectomy with satisfactory tumour-free margins (in three dimensions), characterises surgery with an intent to cure. Until recently, open access surgery remained the ‘gold standard’ for elective colorectal resection in malignant disease. With the advent of laparoscopic surgery in the early 1990s, surgeons introduced laparoscopic techniques to surgical oncology in the abdomen with attendant advantages of minimal surgical access: i.e. minimal abdominal wall wounding with consequent lower inflammatory response, post-operative pain, wound morbidity, superior cosmesis and a better quality of life. Concerns about the oncological appropriateness of laparoscopic surgery in colorectal cancer prompted multiple, large-scale, randomised controlled trials in the mid-1990s. Consequently, Level 1 evidence in the first decade of the twenty-first century validated the long-term oncological soundness of laparoscopic surgery in colorectal cancer when performed by appropriate technique (Schwenk et al., Cochrane Database Syst Rev (3):CD003145, 2005; Clinical Outcomes of Surgical Therapy Study Group, N Engl J Med 350:2050–2059, 2004; Guillou et al., Lancet 365(9472):1718–1726, 2005; Veldkamp et al., Lancet Oncol 6:477–484, 2005; Martel et al., PLoS One 7:e35292, 2012).