Robotic right hemicolectomy with D3 lymphadenectomy, complete mesocolon excision (CME) and intracorporeal anastomosis.

BACKGROUND Complete mesocolic excision (CME) was first described in May 2009 by Werner Hohenberger and his colleagues (1). It arose from the concept of Total Mesorectal Excision illustrated by Heald (2), and consists of sharp dissection of the visceral fascial layer from the parietal one, complete mobilization of the mesocolon with an intact fascia and true central vascular ligation of the supplying arteries and draining veins at their origin. Current evidence suggests this technique is associated with better specimen quality, lower recurrence rates, higher disease-free survival, but also higher incidence of intraoperative injuries and surgical morbidity. CME has become the standard of care in some groups, while in others is performed in subjective selected cases (3). RESULTS In this video, we present the case of a 66-year-old man with cT3aN0 cecum adenocarcinoma and BMI of 29.42 kgs/m2, ASA II. No metastatic disease was identified on the staging CT scans. A robot-assisted right hemicolectomy by Da Vinci Xi platform with complete mesocolic excision including central vascular ligation, D3 lymph node dissection, and mesenteric resection with intact visceral peritoneum was performed. The surgery took 140 minutes. The patient started oral intake 6 hours after the surgery and left hospital on the 2nd postoperative day. Pathological examination confirmed a pT3N0 (0/32) colon adenocarcinoma. CONCLUSIONS Extended right hemicolectomy with complete mesocolic excision and D3 lymph node dissection is a feasible option by the robotic approach, which improves visualization and instrument dexterity.