Abstract
Laparoscopic colectomy is a difficult procedure with a long learning curve. We describe in this study our technique for right- and left-sided laparoscopic medial-to-lateral colectomy. The medial approach involves division of the vascular pedicle first, followed by mobilization of the mesentery toward the abdominal wall, and finally freeing of the colon along the white line of Toldt. This approach allows immediate identification of the plane between the mesocolon and the retroperitoneum and renders the dissection fast and safe. Our series of 50 consecutive laparoscopic colectomies supports this concept. We believe that surgeons familiar with this technique will have an important tool in their armamentarium to circumvent some of the challenges of laparoscopic colectomy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Pappas TN, Jacobs DO. Laparoscopic resection for colon cancer—The end of the beginning? N Engl J Med 2004;350:2091–2092.
Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL. Laparoscopic resection of colon cancer: Consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 2004;18:1163–1185.
Decanini C, Milsom JW, Bohm B, Fazio VW. Laparoscopic oncologic abdominoperineal resection. Dis Colon Rectum 1994;37:552–558.
Sartori CA, Franzato B. The standardization of a technique for laparoscopic left hemicolectomy with radical lymphadenectomy. Chir Ital 1999;51:329–334 (in Italian).
Liang JT, Lai HS, Huang KC, Chang KJ, Shieh MJ, Jeng YM, Wang SM. Comparison of medial-to-lateral versus traditional lateral-to medial laparoscopic dissection sequences for resection of rectosigmoid cancers: Randomized controlled clinical trial. World J Surg 2003;27:190–196.
Barnes JP. Physiologic resection of the right colon. Surg Gynecol Obstet 1952;94:722–726.
Turnbull RB, Kyle K, Watson FR, Spratt J. The influence of the no-touch-isolation technique on survival rates. Ann Surg 1967;166:420–425.
Wiggers T, Jeekel J, Arends JW, Brinkhorst AP, Kluck HM, Luyk CI, Munting JD, Povel JA, Rutten AP, Volovics A. No-touch isolation technique in colon cancer: A controlled prospective trial. Br J Surg 1988;75:409–415.
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J. Laparoscopic-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: A randomized trial. Lancet 2002;359:2224–2229.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pigazzi, A., Hellan, M., Ewing, D.R. et al. Laparoscopic Medial-to-lateral Colon Dissection: How and Why. J Gastrointest Surg 11, 778–782 (2007). https://doi.org/10.1007/s11605-007-0120-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-007-0120-4