AB006. 152. Route to the middle colics

Background: For right sided colonic cancers, it is imperative to obtain an optimum mesocolic specimen with a high tie of the associated vascular pedicles. This necessitates meticulous dissection and step wise approach to the overall operation. Identification and skeletonisation of middle colic artery and its branches do not often follow a standardised approach.

Methods: Live video recording of elective laparoscopic cases, demonstrating approach and technique to allow for complete mesocolic excision with central vascular ligation, for right sided colonic tumours. Exposure of the trunk of the middle colic and its right branch is emphasised.

Results: Sections from our sampled videos illustrating the operative steps. Ileocolic pedicle dissection, superior mesenteric vein identification (SMV) caudal to cranial approach to root of middle colic vessels. This allows for clear identification and address of the middle colic vessel in a manner that is reproducible and teachable.

Conclusions: A step wise approach and appreciation of relevant anatomy is key, especially of the vascular supply to the right colon. Video recording aids in allowing the team to demonstrate the pertinent steps and also encourage self critique and improvement of required surgical skills in order to perform an appropriate operative procedure.

Keywords: Complete mesocolic excision; high tie; middle colic