Procedural key steps in laparoscopic colorectal surgery, consensus through Delphi methodology

Abstract

Expert consensus on the key steps for laparoscopic right hemicolectomy and laparoscopic sigmoid colectomy was reached. These key steps will form the basis for a video-assisted teaching curriculum.

The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision

“…However, with the advent of CME surgery, this notion has changed completely. Even though the debate concerning the potential benefit of CME surgery is ongoing [14], and laparoscopic CME in particular is not generally accepted [15], it is clear that right hemicolectomy with CME is a complex operation that requires a high degree of technical and anatomical skill. Features that are specific for CME surgery are: en-bloc dissection of the surgical trunk along the superior mesenteric vein; the meticulous division of the branches of the gastro-colic trunk (trunk of Henle) down to the pancreatic head; and the strict preservation of the dorsal mesothelium (the mesocolic fascia) of the entire mesocolon.…”

“…Furthermore, the mesenteric root remains fixed to the retroperitoneum which hinders free access to the superior mesenteric vessels. As a result of these shortcomings, the lateral approach has mainly been abandoned [15] and the medial approach has been developed as an alternative [16][17][18]. In this approach, the mobilization commences directly at the fat body of the ileocolic vessels near their origin at the mesenteric root.…”

Iatrogenic ureteral injuries and their prevention in colorectal surgery: results from a nationwide survey

“…Furthermore, guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons [21] and the European Society of Coloproctology [18] do not address this topic at all. The consensus of expert colorectal surgeons through the DELPHI methodology does not consider ureter identification as an important step in either right hemicolectomy or sigmoidectomy [17].…”

Failing to Prepare Is Preparing to Fail

“…in the video, the key procedural steps of the operation, as determined by expert consensus through the Delphi method, are reviewed stepwise with still photography of each step and a descriptive narration providing an overview of the key techniques for each step. 20 next, all of the steps are demonstrated with video footage from experts in the field, again with narration detailing the technical specifics that are depicted in the video.…”