Advances in surgical approaches for laparoscopic radical right hemicolectomy: A literature review

doi:10.3877/cma.j.issn.1674-0793.2026.05.007

Abstract

Abstract:

Currently, patients with tumors located in the right colon are commonly treated with laparoscopic radical right hemicolectomy. Although laparoscopic techniques have made surgery more visual and precise, the varied morphology and variable course of the right colic vessels often pose challenges for surgeons, and improper manipulation may lead to unnecessary intraoperative injuries. Therefore, to better address and overcome the issues of vascular variations and reduce intraoperative injury, we conducted a literature review on the surgical approaches and anatomical guidance for laparoscopic right hemicolectomy, aiming to identify more reasonable, simplified, and individualized surgical approaches.

Key words: Laparoscopes, Colectomy, Intraoperative injury, Surgical approach, Literature review

Xiaojiang Yi, Jiali Liu, Tianming Jiang, Chao Liang, Haipeng Huang, Jingfang Diao. Advances in surgical approaches for laparoscopic radical right hemicolectomy: A literature review[J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(05): 325-329.

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References 28

［1］	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209–249.
［2］	Anania G, Arezzo A, Davies RJ, et al. A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision[J]. Int J Colorectal Dis, 2021, 36(8): 1609–1620.
［3］	Hazebroek EJ, Color Study Group. COLOR: A randomized clinical trial comparing laparoscopic and open resection for colon cancer[J]. Surg Endosc, 2002, 16(6): 949–953.
［4］	Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group[J]. J Clin Oncol, 2007, 25(21): 3061–3068.
［5］	Kinugasa Y, Uehara K, Yamaguchi K, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2024 for the treatment of colorectal cancer[J]. Int J Clin Oncol, 2025, 30(12): 2410–2463.
［6］	Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome[J]. Colorectal Dis, 2009, 11(4): 354–364.
［7］	Gupta A, Garabetian C, Cologne K, et al. Complete mesocolic excision and extended lymphadenectomy: where should we stand?[J]. J Surg Oncol, 2024, 129(2): 338–348.
［8］	Kitaguchi D, Forgione A, Innocenzi C, et al. The role of complete mesocolic excision with central vascular ligation in colon cancer surgery: A systematic review and meta-analysis of prospective trials[J]. Eur J Surg Oncol, 2026, 52(4): 111516.
［9］	Zhuang XY, Zhang JL, Yang XF, et al. Minimally invasive complete mesocolic excision versus conventional right hemicolectomy for right-sided colon cancer: A systematic review and meta-analysis[J]. BMC Surg, 2025, 25(1): 558.
［10］	Matsuda T, Sumi Y, Yamashita K, et al. Anatomy of the transverse mesocolon based on embryology for laparoscopic complete mesocolic excision of right-sided colon cancer[J]. Ann Surg Oncol, 2017, 24(12): 3673.
［11］	Matsuda T, Iwasaki T, Mitsutsuji M, et al. Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy[J]. Surg Endosc, 2015, 29(4): 1001.
［12］	Du S, Zhang B, Liu Y, et al. A novel and safe approach: middle cranial approach for laparoscopic right hemicolon cancer surgery with complete mesocolic excision[J]. Surg Endosc, 2018, 32(5): 2567–2574.
［13］	Nguyen NH, Vu XV, Nguyen VQ, et al. Bach Mai procedure for complete mesocolic excision, central vascular ligation, and D₃ lymphadenectomy in total laparoscopic right hemicolectomy: A prospective study[J]. World J Surg Oncol, 2023, 21(1): 140.
［14］	Yang Y, Jiang X, Zhou Z, et al. Priority management of Henle trunk in cranial-to-caudal approach for laparoscopic right hemicolon cancer surgery[J]. Front Surg, 2022, 9: 883973.
［15］	Huang R, Wang P, Cao Y, et al. Surgical trunk oriented laparoscopic right hemicolectomy (ST-LRH) for right-sided colon cancer[J]. J Vis Exp, 2025(221).
［16］	Fujita J, Uyama I, Sugioka A, et al. Laparoscopic right hemicolectomy with radical lymph node dissection using the no-touch isolation technique for advanced colon cancer[J]. Surg Today, 2001, 31(1): 93–96.
［17］	Feng B, Sun J, Ling TL, et al. Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies[J]. Surg Endosc, 2012, 26(12): 3669–3675.
［18］	Turnbull RB Jr, Kyle K, Watson FR, et al. Cancer of the colon: the influence of the no-touch isolation technic on survival rates[J]. CA Cancer J Clin, 1968, 18(2): 82–87.
［19］	Feng B, Ling TL, Lu AG, et al. Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer[J]. Surg Endosc, 2014, 28(2): 477–483.
［20］	He Z, Zhang S, Xue P, et al. Completely medial access by page-turning approach for laparoscopic right hemi-colectomy: 6-year-experience in single center[J]. Surg Endosc, 2019, 33(3): 959–965.
［21］	Li H, He Y, Lin Z, et al. Laparoscopic caudal-to-cranial approach for radical lymph node dissection in right hemicolectomy[J]. Langenbecks Arch Surg, 2016, 401(5): 741–746.
［22］	Yi X, Li H, Lu X, et al. “Caudal-to-cranial” plus “artery first” technique with beyond D₃ lymph node dissection on the right midline of the superior mesenteric artery for the treatment of right colon cancer: is it more in line with the principle of oncology?[J]. Surg Endosc, 2020, 34(9): 4089–4100.
［23］	Yi X, Liao W, Zhu B, et al. “Caudal to cranial” versus “medial to lateral” approach in laparoscopic right hemicolectomy with complete mesocolic excision for the treatment of stage ⅡandⅢ colon cancer: perioperative outcomes and 5-year prognosis[J]. Updates Surg, 2023, 75(5): 1149–1160.
［24］	Takii Y, Mizusawa J, Kanemitsu Y, et al. The conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colon cancer (JCOG1006): A multicenter, open-label, randomized, phase Ⅲ trial[J]. Ann Surg, 2022, 275(5): 849–855.
［25］	Ishizuka M, Shibuya N, Hachiya H, et al. Influence of the no-touch isolation technique on oncologic outcomes for patients with colon cancer undergoing curative surgery: A systematic review and meta-analysis[J]. Surg Oncol, 2023, 50(32): 101972.
［26］	Tamura K, Fujimoto T, Nagayoshi K, et al. Persistent descending mesocolon and its impact on the short-term outcomes of minimally invasive colorectal surgery: A systematic review and meta-analysis[J]. Surg Today, 2026, 56(7): 1066–1074.
［27］	Strey CW, Wullstein C, Adamina M, et al. Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept[J]. Surg Endosc, 2018, 32(12): 5021–5030.
［28］	Zhang X, Zhang J, Ma P, et al. Tunnel versus medial approach in laparoscopic radical right hemicolectomy for right colon cancer: A retrospective cohort study[J]. BMC Surg, 2022, 22(1): 27.

手术路径	技术要点	技术优势	技术劣势
头侧优先入路	1. 基于胚胎学原理，优先打开网膜囊，以RGEV及ARCV为标志显露Henle干 2. 离断ARCV及MCV根部，沿SMV自头侧向尾侧清扫淋巴结 3. 早期游离横结肠系膜与胰头、十二指肠间隙	1. 早期显露胰腺及Henle干解剖结构，便于安全处理血管 2. 血管结扎前即完成结肠游离，早期可评估肿瘤可切除性 3. 有效避免在狭小空间内操作Henle干及中结肠血管，减少盲目损伤	1. 对术者解剖经验要求高，初学者学习曲线陡峭 2. ARCV及Henle干分支极易损伤，可能导致难以控制的出血 3. 止血过程中可能误伤SMV、MCV或MCA，影响淋巴结清扫彻底性4. 经头侧对MCA根部结扎操作困难，较中间入路无明显优势，尤其仅需结扎右支
中间优先入路	1. 在根部分离结扎回结肠血管、右结肠血管及中结肠血管，沿SMV自下而上清扫淋巴结 2. 再拓展游离升结肠系膜后间隙，最后打开胃结肠韧带及肝结肠韧带，游离结肠肝曲	1. 符合“无接触”原则，早期结扎血管根部，避免肿瘤播散	1. 肥胖或肠系膜肥厚患者SMV显露困难，易进入错误解剖层次 2. 存在“杠杆效应”或“隧道效应”，重要结构易被无意损伤 3. 对术野显露及解剖识别要求高，学习曲线较长，推广受限
尾侧优先入路	1. 以Toldt线为标志进入右半结肠后间隙，扩展Toldt间隙，显露胰头及十二指肠水平段 2. 以十二指肠为内侧引导，切开胰腺前被膜安全进入胰十二指肠前间隙 3. 沿SMV自尾侧向头侧解剖，依次结扎离断各结肠血管 4.最后游离胃结肠韧带进入网膜囊，贯通横结肠后间隙	1. 易于找到正确解剖层次，对肥胖及粘连水肿病例更具优势 2. 腹膜后间隙预先解剖，术中出血便于控制，中转率低 3. 学习曲线较短，对初学者友好，手术时间较中间入路短	1. T4b期肿瘤广泛侵犯输尿管或十二指肠时应用受限 2. 后方间隙游离后肠管偏离原位，牵拉回结肠血管存在SMV出血风险 3. 下腹部或盆腔手术史、持续性降结肠系膜患者存在致密粘连，显露困难，可能需中转其他入路4. 部分学者认为早期接触肿瘤，违反“无接触”原则（但高级别证据不足）
头尾联合入路	1. 首先游离头侧胃结肠系膜融合间隙及横结肠系膜与胰头、十二指肠的融合间隙，或是先从尾侧游离右结肠系膜与腹膜后的融合间隙 2. 将头尾两侧间隙贯通后，最后经中间入路处理血管及清扫淋巴结	1. 充分拓展系膜间隙后血管处理视野开阔，克服中间入路“隧道效应” 2. 头尾间隙贯通后解剖层次清晰，操作安全可控 3. 处理手术难点、提高手术安全性及质量控制方面优势明显	1. 手术步骤相对繁琐，要求术者对头尾两侧解剖均熟练掌握 2. 需助手配合良好，团队磨合要求高

手术路径	技术要点	技术优势	技术劣势
头侧优先入路	1. 基于胚胎学原理，优先打开网膜囊，以RGEV及ARCV为标志显露Henle干 2. 离断ARCV及MCV根部，沿SMV自头侧向尾侧清扫淋巴结 3. 早期游离横结肠系膜与胰头、十二指肠间隙	1. 早期显露胰腺及Henle干解剖结构，便于安全处理血管 2. 血管结扎前即完成结肠游离，早期可评估肿瘤可切除性 3. 有效避免在狭小空间内操作Henle干及中结肠血管，减少盲目损伤	1. 对术者解剖经验要求高，初学者学习曲线陡峭 2. ARCV及Henle干分支极易损伤，可能导致难以控制的出血 3. 止血过程中可能误伤SMV、MCV或MCA，影响淋巴结清扫彻底性4. 经头侧对MCA根部结扎操作困难，较中间入路无明显优势，尤其仅需结扎右支
中间优先入路	1. 在根部分离结扎回结肠血管、右结肠血管及中结肠血管，沿SMV自下而上清扫淋巴结 2. 再拓展游离升结肠系膜后间隙，最后打开胃结肠韧带及肝结肠韧带，游离结肠肝曲	1. 符合“无接触”原则，早期结扎血管根部，避免肿瘤播散	1. 肥胖或肠系膜肥厚患者SMV显露困难，易进入错误解剖层次 2. 存在“杠杆效应”或“隧道效应”，重要结构易被无意损伤 3. 对术野显露及解剖识别要求高，学习曲线较长，推广受限
尾侧优先入路	1. 以Toldt线为标志进入右半结肠后间隙，扩展Toldt间隙，显露胰头及十二指肠水平段 2. 以十二指肠为内侧引导，切开胰腺前被膜安全进入胰十二指肠前间隙 3. 沿SMV自尾侧向头侧解剖，依次结扎离断各结肠血管 4.最后游离胃结肠韧带进入网膜囊，贯通横结肠后间隙	1. 易于找到正确解剖层次，对肥胖及粘连水肿病例更具优势 2. 腹膜后间隙预先解剖，术中出血便于控制，中转率低 3. 学习曲线较短，对初学者友好，手术时间较中间入路短	1. T4b期肿瘤广泛侵犯输尿管或十二指肠时应用受限 2. 后方间隙游离后肠管偏离原位，牵拉回结肠血管存在SMV出血风险 3. 下腹部或盆腔手术史、持续性降结肠系膜患者存在致密粘连，显露困难，可能需中转其他入路4. 部分学者认为早期接触肿瘤，违反“无接触”原则（但高级别证据不足）
头尾联合入路	1. 首先游离头侧胃结肠系膜融合间隙及横结肠系膜与胰头、十二指肠的融合间隙，或是先从尾侧游离右结肠系膜与腹膜后的融合间隙 2. 将头尾两侧间隙贯通后，最后经中间入路处理血管及清扫淋巴结	1. 充分拓展系膜间隙后血管处理视野开阔，克服中间入路“隧道效应” 2. 头尾间隙贯通后解剖层次清晰，操作安全可控 3. 处理手术难点、提高手术安全性及质量控制方面优势明显	1. 手术步骤相对繁琐，要求术者对头尾两侧解剖均熟练掌握 2. 需助手配合良好，团队磨合要求高

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