The lateral-to-medial approach of complete mesocolic excision

Complete mesocolic excision (CME) in the surgical treatment of colon cancer, which was coined by Werner Hohenberger in 2009, entails dissection in predetermined anatomical layers with central ligation of the supplying vessels to achieve maximum local radicality with maximum lymph node yield. Minimally invasive techniques have also been shown to produce better short-term results with comparable long-term oncological outcomes. To achieve these goals and to cope with the sometimes complex anatomical vascular variability, different variations of the preparation in the embryonic layers now exist. The minimally invasive lateral-to-medial approach represents a further development of the historically open procedure and has advantages in the accurate identification of the anatomical layers right at the beginning of the operation. The sensitive retroperitoneal structures on both sides as well as the duodenum, pancreas and the gastrocolic trunk of Henle can be safely spared during laparoscopic right hemicolectomy with CME. Damage to the superior hypogastric plexus and hypogastric nerves is rare and the regional lymphatic drainage area is not opened during retrofascial separation, which possibly provides oncological advantages. In this article the procedure for left and right laparoscopic hemicolectomy with CME is described in detail. In a brief review of the literature the different procedures are discussed.