Robotic Total Mesocolic Excision
In this chapter, we aim to describe the robotic total mesocolic excision (TMCE) technique for colon cancer. We will discuss the basics of TMCE and specifically the robotic approach. Robotic technology offers better dexterity, increased triangulation, and
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Robotic Total Mesocolic Excision Deniz Atasoy, Bilgi Baca, Ismail Hamzaoglu, and Tayfun Karahasanoglu
Introduction
The aim is to remove the colon tumor with all its draining lymphatics and blood supply within an intact envelope. In a In this chapter, we aim to describe the robotic total meso- retrospective population-based study, it was reported that colic excision (TMCE) technique for colon cancer. We will TMCE was associated with better disease-free survival in discuss the basics of TMCE and specifically the robotic stage I–III colon adenocarcinoma compared to conventional approach. Robotic technology offers better dexterity, colon cancer surgery [5]. increased triangulation, and ergonomic superiority. The disAlthough the TMCE concept was first described in 2003, advantages like increased cost and operative time may be its popularity is increasing lately. counterbalanced by achievement of better specimen quality The mesocolic fascia envelops all the colon from rectum to and improved oncologic outcomes, which needs further cecum [2]. The TMCE procedure is meticulously advanced in investigation. We will describe the procedural steps in each the embryologic plane between the mesocolic and retroperitoapproach in detail with special emphasis on the key points in neal fascia [2]. The dissection is advanced within the embryoevery step. logical plane of Toldt’s fascia (mesofascial- retrofascial planes). Injuries to the visceral peritoneum should be avoided. It is reported that excision with an intact mesocolon is associBackground ated with a 15% greater 5-year survival [6]. The idea of en bloc removal of a colon tumor was not new The hypothesis of total mesocolic excision (TMCE) is based before 2003. Turnbull R.B., Jr. [7], described a so-called no- on the concept of total mesorectal excision described by touch isolation technique in 1953, in which the tumor- Heald et al. in 1982 [1]. TMCE includes removal of the bearing colonic segment was handled only after ligation of mesocolon and supplying vessels en bloc with the tumor [2]. the lymphovascular pedicles and transection of the proximal The length of healthy colon to be removed proximal and dis- and distal ends of the colon in order to prevent tumor distal to the tumor differs between European and Japanese semination. He reported that with this technique, 5-year surschools [3]. Vessels should be highly ligated, and the meso- vival of colon tumor patients increased. However, in his colon should have an intact peritoneal envelope [2, 4]. TMCE technique, he didn’t mention about the mesocolic visceral involves high ligation of the supplying vessels both in right- peritoneal envelope and high ligation of the vessels. sided and left-sided colon tumors [4]. Although debated some studies reported that increased lymph node harvest with high-ligation technique was associated with better survival [8–10]. The robotic platform overcomes some of the laparoscopic Electronic Supplementary Material The online version of this chapter (https://doi.org/10.1007/978-3-030-15273-4_
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