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Surgical Endoscopy

, Volume 30, Issue 5, pp 1930–1937 | Cite as

The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision

  • Stefan Benz
  • Yu Tam
  • Andrea Tannapfel
  • Ingo Stricker
Article

Abstract

Background

Current evidence suggests that complete mesocolic excision (CME) for right-sided colon cancer could be beneficial in terms of long-term survival. However, CME is a considerably more complex operation than standard right hemicolectomy; this is especially true for the laparoscopic approach. Consequently, we have explored a new laparoscopic approach that provides surgical radicality at the mesenteric root on the one hand and maximum safety on the other hand.

Methods

The key feature of the uncinate process first approach (UFA) is the commencement of the dissection at the fourth part of the duodenum using a medial to lateral approach, thus mobilizing the whole mesenteric root posteriorly before the central parts of the mesenteric vessels are accessed. Twenty-eight selected patients with right-sided colon cancer underwent surgery using the UFA and were compared with 51 patients who underwent an open CME procedure (CON). In 11/28 and 51/51 patients in the UFA and CON groups, respectively, a planimetric assessment of the specimen was performed.

Results

Surgical time was longer (144.8 vs. 202.5 min; p < 0.000) and postoperative stay shorter (8.0 vs. 10.5 days; p < 0.01) for the laparoscopic approach. The area of the resected mesentery (UFA, 15,097 mm2; CON, 15,788 mm2; p = 0.47) and the lymph node count (UFA, 59.0; CON, 51.0; p = 0.09) was not significantly different; additionally, no difference was observed regarding anastomotic leakage (both n = 0) and postoperative mortality (UFA, 0/28; CON, 1/51; p = 1.0).

Conclusion

Laparoscopic right hemicolectomy with CME using the UFA provides adequate radicality according to the CME principles and seems feasible and as safe as an open technique. However, future trails will have to demonstrate whether the theoretical advantages of the UFA, with a higher degree of mobility and accessibility of the mesenteric root, translate into a significant clinical benefit, especially relative to the other laparoscopic techniques.

Keywords

Uncinate process first approach Complete mesocolic excision Right hemicolectomy Colon cancer Laparoscopic hemicolectomy CME 

Notes

Acknowledgments

The contribution of Mrs Alexandra Gayer in managing the database is gratefully acknowledged.

Compliance with ethical standards

Disclosures

The authors, Professor Tannapfel, Dr. Stricker, Dr. Tam and Professor Benz, have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Stefan Benz
    • 1
  • Yu Tam
    • 2
  • Andrea Tannapfel
    • 2
  • Ingo Stricker
    • 2
  1. 1.Klinik für Allgemein, Viszeral und KinderchirurgieKliniken BöblingenBöblingenGermany
  2. 2.Institut für PathologieRuhruniversität BochumBochumGermany

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