Robotic Total Mesocolic Excision

  • Deniz Atasoy
  • Bilgi Baca
  • Ismail Hamzaoglu
  • Tayfun Karahasanoglu


In this chapter, we aim to describe the robotic total mesocolic excision (TMCE) technique for colon cancer. We will discuss the basics of TMCE and specifically the robotic approach. Robotic technology offers better dexterity, increased triangulation, and ergonomic superiority. The disadvantages like increased cost and operative time may be counterbalanced by achievement of better specimen quality and improved oncologic outcomes, which needs further investigation. We will describe the procedural steps in each approach in detail with special emphasis on the key points in every step.


Total mesocolic excision Robotic approach Colon cancer Complete mesocolic excision 

Supplementary material

Video 8.1

Dissection and clipping of ileocolic artery and vein (MP4 88361 kb)

Video 8.2

Dissection and clipping of Henle’s trunk (MP4 131428 kb)

Video 8.3

Gastrocolic vein dissection (MP4 150038 kb)

Video 8.4

Preserving peritoneal window and surgical trunk (MP4 134736 kb)

Video 8.5

Transection of bowel loops (MP4 91949 kb)

Video 8.6

Quality of the specimen (MP4 89409 kb)

Video 8.7

Intracorporeal anastomosis (MP4 90776 kb)

Video 8.8

Ligation of the IMV (MP4 66559 kb)

Video 8.9

Splenic flexure mobilization (MP4 150795 kb)

Video 8.10

Specimen extraction (MP4 82638 kb)

Video 8.11

Colocolic anastomosis (MP4 150235 kb)

Video 8.12

Ligation of the left colic vessels (MP4 145043 kb)


  1. 1.
    Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.CrossRefGoogle Scholar
  2. 2.
    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; discussion 364–355.CrossRefGoogle Scholar
  3. 3.
    West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30:1763–9.CrossRefGoogle Scholar
  4. 4.
    West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol Off J Am Soc Clin Oncol. 2010;28:272–8.CrossRefGoogle Scholar
  5. 5.
    Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Bols B, Ingeholm P, Rasmussen LA, Jepsen LV, Iversen ER, Kristensen B, Gogenur I. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol. 2015;16:161–8.CrossRefGoogle Scholar
  6. 6.
    West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol. 2008;9:857–65.CrossRefGoogle Scholar
  7. 7.
    Turnbull RB Jr, Kyle K, Watson FR, Spratt J. Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg. 1967;166:420–7.CrossRefGoogle Scholar
  8. 8.
    Willaert W, Mareel M, Van De Putte D, Van Nieuwenhove Y, Pattyn P, Ceelen W. Lymphatic spread, nodal count and the extent of lymphadenectomy in cancer of the colon. Cancer Treat Rev. 2014;40:405–13.CrossRefGoogle Scholar
  9. 9.
    Johnson PM, Porter GA, Ricciardi R, Baxter NN. Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24:3570–5.CrossRefGoogle Scholar
  10. 10.
    Schumacher P, Dineen S, Barnett C Jr, Fleming J, Anthony T. The metastatic lymph node ratio predicts survival in colon cancer. Am J Surg. 2007;194:827–31; discussion 831–822.CrossRefGoogle Scholar
  11. 11.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet (London, England). 2002;359:2224–9.CrossRefGoogle Scholar
  12. 12.
    Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.CrossRefGoogle Scholar
  13. 13.
    Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA. 2017;318:1569–80.CrossRefGoogle Scholar
  14. 14.
    Carmichael JC, Stamos MJ. Right hemicolectomy and ileocecectomy: laparoscopic approach. In: Bardakcioglu O, editor. Advanced techniques in minimally invasive and robotic colorectal surgery. Boston: Springer; 2015.Google Scholar
  15. 15.
    Benlice C, Stocchi L, Costedio MM, Gorgun E, Kessler H. Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection. Dis Colon Rectum. 2016;59:743–50.CrossRefGoogle Scholar
  16. 16.
    Matsuda T, Iwasaki T, Mitsutsuji M, Hirata K, Maekawa Y, Tsugawa D, Sugita Y, Sumi Y, Shimada E, Kakeji Y. Cranially approached radical lymph node dissection around the middle colic vessels in laparoscopic colon cancer surgery. Langenbeck’s Arch Surg. 2015;400:113–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Deniz Atasoy
    • 1
  • Bilgi Baca
    • 1
    • 2
  • Ismail Hamzaoglu
    • 1
  • Tayfun Karahasanoglu
    • 1
  1. 1.Department of General SurgeryAcibadem Mehmet Ali Aydinlar University, School of MedicineIstanbulTurkey
  2. 2.Atakent Acibadem HastanesiKucukcekmece/IstanbulTurkey

Personalised recommendations