Laparoscopic right hemicolectomy with CME: standardization using the "critical view" concept

Strey CW, Wullstein C, Adamina M, Agha A, Aselmann H, Becker T, Grützmann R, Kneist W, Maak M, Mann B, Moesta KT, Runkel N, Schafmayer C, Tuerler A, Wedel T, Benz S (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Surgical Endoscopy Springer Verlag (Germany)

Book Volume: 32

Pages Range: 5021-5030

Journal Issue: 12

DOI: 10.1007/s00464-018-6267-0

Abstract

BACKGROUND: Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding and carries the risk of serious complications, especially when performed laparoscopically. A standardized procedure that minimizes technical hazards and facilitates teaching is, therefore, highly desirable. METHODS: An expert group of surgeons and one anatomist met three times. The initial aim was to achieve consensus about the surgical anatomy before agreeing on a sequence for dissection in laparoscopic CME. This proposal was evaluated and discussed in an anatomy workshop using post-mortem body donors along with videos of process-informed procedures, leading to a definite consensus. RESULTS: In order to provide a clear picture of the surgical anatomy, the "open book" model was developed, consisting of symbolic pages representing the corresponding dissection planes (retroperitoneal, ileocolic, transverse mesocolic, and mesogastric), vascular relations, and radicality criteria. The description of the procedure is based on eight preparative milestones, which all serve as critical views of safety. The chosen sequence of the milestones was designed to maximize control during central vascular dissection. Failure to reach any of the critical views should alert the surgeon to a possible incorrect dissection and to consider converting to an open procedure. CONCLUSION: Combining the open-book anatomical model with a clearly structured dissection sequence, using critical views as safety checkpoints, may provide a safe and efficient platform for teaching laparoscopic right hemicolectomy with CME.

Authors with CRIS profile

Robert Grützmann Lehrstuhl für Allgemein- und Viszeralchirurgie Matthias Maak Medizinische Fakultät

Involved external institutions

Universitätsklinikum Schleswig-Holstein (UKSH) DE Germany (DE) Kantonsspital Winterthur (KSW) CH Switzerland (CH) HELIOS Kliniken DE Germany (DE) DRK-Krankenhaus Clementinenhaus DE Germany (DE) Johannes Gutenberg-Universität Mainz (JGU) DE Germany (DE) Krankenhaus Diakovere Friederikenstift Hannover DE Germany (DE) Städtisches Klinikum München DE Germany (DE) Klinikverbund Südwest (Sindelfingen-Böblingen, Calw, Nagold, Leonberg, Herrenberg) DE Germany (DE) Augusta-Kranken-Anstalt gGmbH DE Germany (DE) Christian-Albrechts-Universität zu Kiel DE Germany (DE) Klinikum Region Hannover DE Germany (DE) Sana Kliniken AG DE Germany (DE) Johanniter-Krankenhaus Bonn DE Germany (DE)

How to cite

APA:

Strey, C.W., Wullstein, C., Adamina, M., Agha, A., Aselmann, H., Becker, T.,... Benz, S. (2018). Laparoscopic right hemicolectomy with CME: standardization using the "critical view" concept. Surgical Endoscopy, 32(12), 5021-5030. https://doi.org/10.1007/s00464-018-6267-0

MLA:

Strey, Christoph Werner, et al. "Laparoscopic right hemicolectomy with CME: standardization using the "critical view" concept." Surgical Endoscopy 32.12 (2018): 5021-5030.

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