Abstract:

4K fluorescent laparoscopic extended right hemicolectomy with total mesocolon excision combined with D3 lymph node dissection is indicated for patients with ascending colon cancer and colonic hepatic flexure cancer, staged as T_1-4aN_0-2M₀. The surgical approach was a medial approach in priority combined with cranial-to-caudal approach. The procedure should follow the principles of asepsis and tumor-free, do not touch it and en-bloc resection, and keep the surgical process coherent. The whole procedure is performed under the guidance of membrane anatomy, ensuring that the dorsal urogenital fascial layer and the dorsal layer of the mesocolon are smooth, and the membrane structures in the surgical field should be intact and unbroken, so as to avoid the spillage of adipose particles. The medial border of D3 radical dissection is defined by the right margin of the superior mesenteric artery, preserving the nerve plexus on the surface of the superior mesenteric artery, and the ileocolic vascular, the right colic vascular, and the middle colic vascular should be exposed under the fluorescent tracer navigation, and the D3 lymphadenectomy was performed by ligating and transecting at the roots of the vessels as mentioned the above. The surgical trunk of the superior mesenteric vein and the Henle's trunk were fully exposed to avoid bleeding of the venous branches. The critical technique of CME and D3 lymphadenectomy is maintaining proper tension among tissues and organs, incising the membrane bridge, entering the right Toldt fascial space, identifying and keeping the intact membranous structure.

Key words: Colonic Neoplasms, Complete Mesocolic Excision, D3 Lymph Node Dissection, Infrapyloric Lymph Node Dissection