Laparoscopic Right Colectomy
In the surgical technique for laparoscopic right colectomy (including ileocaecal resection), it is easy to understand the fascial composition based on the medial-retroperitoneal approach; thus, the surgical technique becomes evident. The anatomical landma
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6.1
Introduction
In the laparoscopic right colectomy (LapRC) surgical technique (including ileocaecal resection), it is easy to understand the fascial composition based on the medial-retroperitoneal approach, and thus the surgical technique becomes evident. Our laparoscopic right colectomy surgeries have a general rule that the procedures involving division of the mesentery, ligation of vessels, and anastomosis are to be performed under small auxiliary laparotomy of the epigastric region due to its “rapidity” and “safety”.
6.2
Resection Range and Degree of Lymph Node Dissection
As has already been described in the Chap. 1, since the concept of the surgical trunk by Gillot [1] (Fig. 6.1) was first introduced in Japan in the 1970s, two main views are prevalent with regards to lymph node dissection for right colon cancer. Namely, lymph node dissection of the main lymph node based on the dominant artery root and lymph node dissection of the surgical trunk based on the lymph flow of Gillot [2]. No definitive conclusions have been reached as to which is more correct; however, the former calls for the dissection of portions where the lymph flow is missing, while in the latter the theory of lymph flow is only emphasised and whether the dissection of all this part is actually clinically meaningful has not been determined.
6.3
Fascial Composition of the Right-Side Colon
As for the configuration of the right colon, it can be considered as divided into a simple fusion fascia between the colon and retroperitoneum at the caudal side (Fig. 6.2) and a relatively confused fusion fascia at the cranial pancreatoduodenal portion (Fig. 6.3). In the former, the right colon and
6
retroperitoneum are fused to become the right fusion fascia of Toldt and the ascending colon is buried in the retroperitoneum (Fig. 6.2a, b). In the latter, it is easy to understand the fascial composition if the embryologic processes are divided into two stages (Fig. 6.3a, b). That is, the second portion of the duodenum that was accompanied by a dorsal mesentery falls to the right, forming the posterior pancreatic fascia of Treitz between the parietal peritoneum and the pancreatoduodenal region (Fig. 6.3c). Then, the ascending colon covers the head of the pancreatoduodenal region when the intestinal rotation is completed, and it forms the right fusion fascial of Toldt and the anterior pancreatic fascia (Fig. 6.3e). In other words, the right fusion fascia of Toldt is divided into the posterior pancreatic fascia of Treitz dorsally and the anterior pancreatic fascia ventrally at the margin of the second portion of the duodenum (Fig. 6.3e). Additionally, the hepatic flexure is located at the transition of the transverse colon with the mesocolon and the ascending colon, in which the mesocolon is fused with the posterior abdominal wall. In addition, with regards to the relation between the transverse colon and the second portion of the duodenum, three fusion patterns can be considered in three degrees of fusion. That is, there are fusions between the ventra
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