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

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...

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Autores principales: Strey, Christoph Werner, Wullstein, Christoph, Adamina, Michel, Agha, Ayman, Aselmann, Heiko, Becker, Thomas, Grützmann, Robert, Kneist, Werner, Maak, Matthias, Mann, Benno, Moesta, Kurt Thomas, Runkel, Norbert, Schafmayer, Clemens, Türler, Andreas, Wedel, Thilo, Benz, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208708/
https://www.ncbi.nlm.nih.gov/pubmed/30324463
http://dx.doi.org/10.1007/s00464-018-6267-0
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author Strey, Christoph Werner
Wullstein, Christoph
Adamina, Michel
Agha, Ayman
Aselmann, Heiko
Becker, Thomas
Grützmann, Robert
Kneist, Werner
Maak, Matthias
Mann, Benno
Moesta, Kurt Thomas
Runkel, Norbert
Schafmayer, Clemens
Türler, Andreas
Wedel, Thilo
Benz, Stefan
author_facet Strey, Christoph Werner
Wullstein, Christoph
Adamina, Michel
Agha, Ayman
Aselmann, Heiko
Becker, Thomas
Grützmann, Robert
Kneist, Werner
Maak, Matthias
Mann, Benno
Moesta, Kurt Thomas
Runkel, Norbert
Schafmayer, Clemens
Türler, Andreas
Wedel, Thilo
Benz, Stefan
author_sort Strey, Christoph Werner
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-018-6267-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-62087082018-11-09 Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept Strey, Christoph Werner Wullstein, Christoph Adamina, Michel Agha, Ayman Aselmann, Heiko Becker, Thomas Grützmann, Robert Kneist, Werner Maak, Matthias Mann, Benno Moesta, Kurt Thomas Runkel, Norbert Schafmayer, Clemens Türler, Andreas Wedel, Thilo Benz, Stefan Surg Endosc Dynamic Manuscript 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00464-018-6267-0) contains supplementary material, which is available to authorized users. Springer US 2018-10-15 2018 /pmc/articles/PMC6208708/ /pubmed/30324463 http://dx.doi.org/10.1007/s00464-018-6267-0 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Dynamic Manuscript
Strey, Christoph Werner
Wullstein, Christoph
Adamina, Michel
Agha, Ayman
Aselmann, Heiko
Becker, Thomas
Grützmann, Robert
Kneist, Werner
Maak, Matthias
Mann, Benno
Moesta, Kurt Thomas
Runkel, Norbert
Schafmayer, Clemens
Türler, Andreas
Wedel, Thilo
Benz, Stefan
Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept
title Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept
title_full Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept
title_fullStr Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept
title_full_unstemmed Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept
title_short Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept
title_sort laparoscopic right hemicolectomy with cme: standardization using the “critical view” concept
topic Dynamic Manuscript
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208708/
https://www.ncbi.nlm.nih.gov/pubmed/30324463
http://dx.doi.org/10.1007/s00464-018-6267-0
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