Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection

Laparoscopic right hemicolectomy (LRH) has been proven to be an effective and safe surgical approach. However, due to the numerous vessels involved in the right colon and the variability of individual anatomy, LRH still faces many challenges. In the early stages, two surgical approaches were reported in the literature: the lateral-to-medial and medial-to-lateral approaches. The lateral-to-medial approach is typically used in open surgery. Currently, with the development of technology, multiple surgical approaches for LRH are available. This paper reports on a caudal approach method, the caudal-to-cranial approach, combined with complete mesocolic excision (CME) and D3 lymph node dissection. The described procedural sequence-prioritizing the establishment of anatomical planes before vascular dissection-may facilitate precise vascular management by first defining the surgical landscape. This approach appears to enhance procedural safety and could potentially reduce operative difficulty by improving anatomical orientation. Our initial experience suggests that this method supports a thorough lymph node dissection, demonstrating its feasibility for performing CME and D3 lymph node dissection.