Bach Mai Procedure for complete mesocolic excision, central vascular ligation, and D3 lymphadenectomy in total laparoscopic right hemicolectomy: a prospective study

World Journal of Surgical Oncology

Research

Thanh Khiem Nguyen¹  Vu Quang Nguyen¹  Ham Hoi Nguyen¹  Ngoc Hung Nguyen¹  Huy Du Nguyen¹  Tuan Hiep Luong¹  The Hiep Nguyen²  Xuan Vinh Vu² 

[1] Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam;Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam;Department of Surgery, Hanoi Medical University, Hanoi, Vietnam;

关键词: Total laparoscopic right hemicolectomy;    Complete mesocolic excision;    Central vascular ligation;    D3 lymphadenectomy;   

DOI  :  10.1186/s12957-023-03026-5

 received in 2023-04-03, accepted in 2023-04-29,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeTotal laparoscopic right hemicolectomy with complete mesocolic excision (CME), central vascular ligation (CVL), and D3 lymphadenectomy is still the most challenging colon procedures for gastrointestinal surgeons. We herein report the technical details and our preliminary experience of Bach Mai Procedure — a novel-combining (cranial, medial to lateral, and caudal) approach with early resection of the terminal ileum.MethodsThe dissection stage was central vascular isolation and ligation by a combined multiple approaches in the following four steps: cranial approach, dissecting along the inferior aspect of pancreatic isthmus to reveal the middle colic vessels and the anterior aspect of the superior mesentery vein and then exposed the right gastroepiploic vein and the trunk of Henle; medial-to-lateral approach, exposing the surgical axis — the superior mesenteric vascular axis and then early resection of the terminal ileum to open the dissection from the bottom up; and caudal approach, radical ligation of the ileocecal artery and right colic artery (central vascular ligation), lymph node dissection (D3 lymphadenectomy), and resecting the Toldt fascia of the colon to release the entire right colon from the abdominal wall.ResultsIn 12 months, there were 32 cases of primary right-sided colon malignancies that have undergone tLRHD3, CME/CVL based on the Bach Mai Procedure. In 3 cases (9.4%), the tumor site was hepatic flexure. The median of lymph node number (LNN) was 38, with the maximum number which was 101. No serious postoperative complications (grade 3 or higher) neither inhospital mortality was detected.ConclusionThis Bach Mai procedure, a novel-combining approach with early resection of the terminal ileum, is technically feasible and safe for tLRHD3, CME/CVL. Further investigations and follow-up must be proceeded to evaluate the long-term outcomes of our technique.

【 授权许可】

CC BY   
© The Author(s) 2023

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