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Video ViewAttendees 1

Session: Ongoing Videos for CME

VM13 - Laparoscopic Right Extended Hemicolectomy with Complete Mesocolic Excision and Central Venous Ligation: A Video Vignette

Saturday, June 1, 2024
10:00 AM – 1:30 PM ET, USA
Location: Baltimore Convention Center, Hall BCD

    Video Presentation(s)

  • Devesh S. Ballal, MS, MCh(surgical Oncology)

    Colorectal Fellow
    Advocate Lutheran General Hospital
    Advocate Lutheran General Hospital, Park Ridge, Illinois
    Des Plaines, IL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Ad

    Ashwin deSouza, MS, MCh, MRCSEd, DNB, FCPS, MNAMS

    Professor & Surgeon
    Tata Memorial Centre & Homi Bhabha National Institute, Mumbai, India
    Mumbai, Maharashtra, India

    Disclosure information not submitted.

  • MK

    Mufaddal K. Kazi, MS, MCh

    Associate Professor
    Tata Memorial Hospital
    Mumbai, Maharashtra, India

    Disclosure information not submitted.

    • Senior Author(s)

  • Avanish P. Saklani, MS, FRCS

    Professor and Chief of Colorectal Services
    Tata Memorial Hospital, Mumbai
    Tata Memorial hospital , Mumbai
    Mumbai, Maharashtra, India

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

Purpose/Background: Complete mesocolic excision with central vascular ligation (CME-CVL) has been shown to offer a 10% improvement in disease free survival in node positive right colon cancers. This is a technically demanding laparoscopic procedure with a steep learning curve requiring dissection over the the superior mesenteric vein and can lead to fatal complications. Further, there is no standardisation of the CME-CVL procedure, with a lot of variability in the extent of SMV dissection.

Methods/Interventions: We present a didactic video presentation of a laparoscopic right hemicolectomy with complete mesocolic excision and central venous ligation (CME-CVL) performed at a tertiary cancer institution in India. All right hemicolectomies performed at our institute entail a CME-CVL with a complete dissection of the Surgical Trunk of Gillot, which is the area of the SMV between the Ileocolic and Middle colic veins.

Results/Outcomes: While of questionable benefit in early and node negative cancers, CME-CVL has been shown to have superior oncological outcomes in node positive right colon cancers, with minimal additional morbidity when performed by experienced surgeons at high volume centres. Standardisation of the surgical procedure allows for reproducible outcomes and reduction in surgical morbidity and time.

Conclusion/Discussion: A thorough understanding of the vascular anatomy of the right colon combined with good exposure and gentle handling of the SMV is paramount towards achieving good results in the technically demanding procedure of CME-CVL for right colon cancers.