VM15 - Standardized Robotic Japanese D3 Dissection with an Inferior Approach for Right Colon Cancer

Purpose/Background: There are a variety of surgical techniques for right hemicolectomy because of its anatomical characteristics. Especially, there are three major approaches: cranial approach, medial approach, and inferior approach. We have adopted an inferior approach, because we can easily keep deeper layer and radial margin in patients with advanced colon cancer. Additionally, robot is useful in precise procedure.

Methods/Interventions: We will present a video regarding the standardized robotic Japanese D3 dissection with an inferior approach for right colon cancer.

Results/Outcomes: First, the mobilization of right colon and small intestine along with appropriate layer is performed. During the mobilization, keeping the appropriate surgical plane is essential. Duodenum and pancreas are preserved. The next step is a lymph node dissection. After ileocolic vessels are divided, lymph node dissection along with surgical trunk is performed. One of the knacks is a marking of the extent of lymph node dissection by an electric cautery when the superior mesenteric vein is recognized. After dissecting the lymph node around the root of middle colic artery, only right branches of middle colic vessels are divided. Thereafter, accessory right colic vein from gastrocolic trunk is divided. After extracorporeal anastomosis, mesentery is sutured and closed.

Conclusion/Discussion: Robotic inferior approach for right colon cancer is safe from technical and oncological point of view. Especially, stable operative field is considered to contribute to safe surgery. Radial margin as well as D3 lymph node dissection is important for prevention of local recurrence.