Operational approaches for laparoscopic complete mesocolic excision in right hemicolon cancer

Complete mesocolic excision (CME) has the potential to become the standard procedure for colon cancer surgery as a result of its effectiveness in reducing local recurrence rate and improving prognosis. There are two strategies to perform CME: medial and lateral. Researchers have demonstrated that laparoscopic CME via medial access is comparable to a traditional open surgery. Technically, we proposed two approaches for medial access: hybrid medial approach (HMA) and completely medial approach (CMA). HMA involves the entrance to the intermesenteric space (IMS) by an incision of the gastrocolonic ligament followed by the dissection of the middle colic vessels and the Henle trunk in a top-to-bottom fashion. The approach is capped by the dissection of the inferior edge of the pancreas, requiring the blending of both top-to-bottom and bottom-to-top approaches. CMA, on the other hand, involves a bottom-to-top approach in every step, including the entrance of IMS through transverse retrocolic space (TRCS); dissection of the middle colic vessels and the Henle trunk; and dissection of the inferior edge of the pancreas. According to the previous research of our medical center, laparoscopic CME via the total medial approach is safe and technically feasible after the precise identification of the surgical planes and spaces for the right hemicolon. Meanwhile, this procedure reduces operation time and has fewer vessel-related complications, which is a better choice for right hemicolectomy.