Usefulness of a Precursory Small Epigastric Midline Incision during Laparoscopic Right Hemicolectomy

Abstract

Objectives: During laparoscopic right hemicolectomy, many surgeons make a small incision near the umbilicus after the routine intraperitoneal operation. In this study, we created a precursory small epigastric incision at the center of a line connecting the xiphoid process and umbilicus (the M point, an empirically determined position) at the start of surgery prior to laparoscopic manipulation. This study aimed to determine whether the small incision at the center of the M point was a suitable position through which the right hemicolon is extracted. Methods: The subjects included 148 patients who underwent laparoscopic right hemicolectomy at our hospital between January 2013 and December 2019. We measured the distance between the M point and the gastrocolic trunk (GCT) root at the base of the transverse mesocolon and the middle colic artery (MCA) root on preoperative contrast-enhanced computed tomography images. Results: We found that the GCT and MCA roots are located within a radius of 1.5 cm from the M point, suggesting that the base of the transverse mesentery was located almost directly below the M point. Comparisons based on sex differences and body mass index (BMI) also revealed that the transverse mesocolon root is closer to the M point in men and overweight patients. Conclusions: From these results, the placement of a precursory small epigastric midline incision not only allows for a safe insertion of the first laparoscopic port in a short period of time but also facilitates safe transection and anastomosis due to the proximity of the M point to the transverse mesocolon root.