Importance of the Duodenal Window and Fredet’s Fascia in Laparoscopic Right Hemicolectomy: Technical Note

2021 ◽  
Vol 39 ◽  
Author(s):  
Giovanni Tebala ◽  
◽  
Salomone Di Saverio ◽  
Gaetano Gallo ◽  
Roberto Cirocchi ◽  
...  
Keyword(s):  
Visceral Obesity ◽  
Right Hemicolectomy ◽  
Technical Note ◽  
Easy Access ◽  
Transverse Mesocolon ◽  
Anatomical Dissection ◽  
Right Border ◽  
Laparoscopic Right Hemicolectomy ◽  
The Right ◽  
Almost All

Background: Laparoscopic right hemicolectomy requires a precise anatomical dissection to mobilise the right and proximal transverse mesocolon, following the avascular fusion planes of Toldt and Fredet. Fredet’s plane is crucial to the preparation of the origin of vessels. Easy access to Fredet’s and Toldt’s fasciae can be obtained through the “duodenal window”, a flimsy area of the root of the proximal transverse mesocolon, the margins of which are the right border of the superior mesenteric pedicle, the ileocolic pedicle, the right colic pedicle and the marginal artery. Method: We propose that dissection of the duodenal window should be the first step in laparoscopic right hemicolectomy, to obtain easy access to the duodenopancreatic plane and prepare the fascia. Results: This “duodenal window-first” technique has been applied in 45 laparoscopic right hemicolectomies and 14 laparoscopic extended right hemicolectomies, with only two conversions to open surgery. The duodenal window was easily identified in all but 3 cases with significant visceral obesity. No significant intra- or postoperative morbidity was recorded in these cases and the median postoperative length of stay was 4 days. All resections were R0 and an adequate number of retrieved lymph nodes were obtained in almost all cases. Conclusion: The duodenal window-first approach is a feasible and safe technique to standardise the first steps of radical laparoscopic right hemicolectomy, allowing prompt and complete anatomical identification and dissection.

Retrocolic Spaces: Anatomy of the Surgical Planes in Laparoscopic Right Hemicolectomy for Cancer

2011 ◽  
Vol 77 (11) ◽  
pp. 1546-1552 ◽  
Author(s):  
Ce Zhang ◽  
Zi-Hai Ding ◽  
Hai-Tao Yu ◽  
Jiang Yu ◽  
Ya-Nan Wang ◽  
...  
Keyword(s):  
Superior Mesenteric Vein ◽  
Right Hemicolectomy ◽  
Healthy Individuals ◽  
Transverse Mesocolon ◽  
Inferior Margin ◽  
Computed Tomography Images ◽  
Laparoscopic Right Hemicolectomy ◽  
Fascial Spaces ◽  
The Right ◽  
Anterior Posterior

To explore the regional anatomy of the fasciae and spaces around the right-side colon from laparoscopic perspective, we observed the location, extension, and boundaries of the spaces around the right-side colon in seven cadavers and in 49 patients undergoing laparoscopic right hemicolectomy for cancer, and reviewed computed tomography images from patients and healthy individuals. Between the ascending mesocolon and prerenal fascia (PRF), there was a right retrocolic space (RRCS), which extended in all directions. The anterior, posterior, medial, lateral, cranial, and caudal boundaries of the RRCS were the ascending mesocolon, PRF, superior mesenteric vein, right paracolic sulcus, inferior margin of the duodenum, and inferior margin of the mesentery radix, respectively. Between the transverse mesocolon and the pancreas and duodenum, there was a transverse retrocolic space, which was enclosed cranially by the radix of the transverse mesocolon. In CT images, healthy PRF was noted as slender line of middle density, continuing to the transverse fascia. The retrocolic spaces was unidentifiable, unless they were filled with retroperitoneal lesions. The RRCS and transverse retrocolic space are natural surgical planes for laparoscopic right hemicolectomy for cancer. The boundaries of these fusion fascial spaces are the best access, and the PRF is the best guide.

scholarly journals External auditory canal lesion: colorectal metastatic adenocarcinoma

2018 ◽  
pp. bcr-2018-224876 ◽  
Author(s):  
Aswathy James ◽  
Sharad Karandikar ◽  
Shobhit Baijal
Keyword(s):  
External Auditory Canal ◽  
Primary Tumour ◽  
Right Hemicolectomy ◽  
R0 Resection ◽  
Internal Auditory Meatus ◽  
Tissue Mass ◽  
Ascending Colon Cancer ◽  
Laparoscopic Right Hemicolectomy ◽  
The Right ◽  
Nose And Throat

The patient presented to the ear, nose and throat clinic with failed conservative treatment of persistent right otitis externa. On examination, the roof of the right ear canal was polypoid and the tympanic membrane could not be visualised. There was a fragile mass noted in the external auditory canal (EAC) which on microsuction started to bleed. CT internal auditory meatus and MRI internal auditory meatus identified soft tissue mass in the EAC. The patient underwent urgent examination under anaesthetic of the ear and biopsies were taken. He had a background of ascending colon cancer; Duke’s C1, pT4, N1 M0, R0 resection and had undergone laparoscopic right hemicolectomy with adjuvant chemotherapy, in the previous year. The biopsy results proved that the mass in the EAC was due to metastatic deposit of colorectal primary tumour. The patient also had a full body CT which revealed other new metastases. The patient is being treated with palliative chemotherapy.

scholarly journals Systematic review of comparing single-incision versus conventional laparoscopic right hemicolectomy for right colon cancer

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Xin Liu ◽  
Wei-hong Yang ◽  
Zhou-guang Jiao ◽  
Ji-fu Zhang ◽  
Rui Zhang
Keyword(s):  
Colon Cancer ◽  
Meta Analysis ◽  
Right Hemicolectomy ◽  
Right Colon ◽  
Chi Square ◽  
Right Colon Cancer ◽  
Laparoscopic Right Hemicolectomy ◽  
Operation Duration ◽  
The Right

Abstract Background Single-incision laparoscopic right hemicolectomy (SILS) has long used in surgery for a long time. However, there is barely a systemic review related to the comparison between the SILS and the conventional laparoscopic right hemicolectomy (CLS) for the right colon cancer in the long term follow-up. Herein, we used the most recent articles to compare these two techniques by meta-analysis. Methods We searched PubMed, Web of Science, Cochrane Library and Wanfang databases to compare SILS with CLS for right colon cancer up to May 2019. The operative, postoperative, pathological and mid-term follow-up outcomes of nine studies were extracted and compared. Results A total of 1356 patients participated in 9 studies, while 653 patients were assigned to the SILS group and 703 patients were assigned to the CLS group. The patients’ baselines in the SILS group were consistent with those in the CLS group. Compared to the CLS group, the SILS group had a shorter operation duration (SMD − 23.49, 95%CI − 36.71 to − 10.27, P < 0.001, chi-square = 24.11), shorter hospital stay (SMD − 0.76, 95% `CI − 1.07 to − 0.45, P < 0.001, chi-square = 9.85), less blood loss (SMD − 8.46, 95% CI − 14.59 to − 2.34; P < 0.05; chi-square = 2.26), smaller incision length (SMD − 1.60, 95% CI − 2.66 to − 0.55, P < 0.001; chi-square = 280.44), more lymph node harvested (SMD − 0.98, 95% CI − 1.79 to − 0.16, P < 0.05; chi-square = 4.61), and a longer proximal surgical edge (SMD − 0.51, 95% CI − 0.93 to − 0.09, P < 0.05; chi-square = 2.42). No significant difference was found in other indexes. After we removed a single large study, we performed another meta-analysis again. The operation duration in the SILS group was still better than that in the CLS group. Conclusion SILS could be a faster and more reliable approach than CLS for the right colon cancer and could accelerate patient recovery, especially for patients with a low BMI.

scholarly journals Laparoscopic Right Hemicolectomy for Appendiceal Mucocele

2021 ◽  
Vol 64 (3) ◽  
pp. 165-169
Author(s):  
Eva Kudelová ◽  
Martin Grajciar ◽  
Marek Smolar ◽  
Michal Kalman ◽  
Ludovit Laca
Keyword(s):  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Right Hemicolectomy ◽  
Cystic Mass ◽  
Lower Quadrant ◽  
Appendiceal Mucocele ◽  
Laparoscopic Right Hemicolectomy ◽  
The Right ◽  
Right Lower Quadrant ◽  
Ct And Mri

Appendiceal mucocele is a rare disease with an incidence of 0.07–0.63% of all appendectomies and was first described in 1842 by Carl von Rokitansky. It is defined as an abnormal intraluminal accumulation of mucin. The clinical picture of AM can vary from asymptomatic mass in the right lower quadrant to symptoms of acute appendicitis. In some cases, AM can be found accidentally on CT performed due to other reasons or during surgery. Diagnosis consists mainly of imaging methods such as ultrasound, CT, and MRI with the finding of encapsulated cystic mass with calcifications. The main goal of surgical treatment is to remove an intact mucocele and prevent spillage of mucin into the peritoneal cavity. We present a case of large mucocele treated with laparoscopic right hemicolectomy.

scholarly journals Development of central auditory processes in Polish children and adolescents at the age from 7 to 16 years

2021 ◽  
Author(s):  
Monika Lewandowska ◽  
Rafał Milner ◽  
Małgorzata Ganc ◽  
Elżbieta Włodarczyk ◽  
Joanna Dołżycka ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
School Students ◽  
Frequency Pattern ◽  
Speech In Noise ◽  
Age Related ◽  
Right Ear Advantage ◽  
The Right ◽  
Almost All ◽  
Test Retest Reliability ◽  
Auditory Processes

AbstractThere are discrepancies in the literature regarding the course of central auditory processes (CAP) maturation in typically developing children and adolescents. The purpose of the study was to provide an overview of age – related improvement in CAP in Polish primary and secondary school students aged 7–16 years. 180 children/adolescents, subdivided into 9 age categories, and 20 adults (aged 18–24 years) performed the Dichotic Digit Test (DDT), Duration Pattern Test (DPT), Frequency Pattern Test (FPT), Gap Detection Test (GDT) and adaptive Speech-in-Noise (aSpN). The 12-year-olds was retested after w week. We found the age effects only for the DDT, DPT and FPT. In the right ear DDT the 7-year-olds performed more poorly than all groups ≥12. In the left ear DDT both 7- and 8-year-olds achieved less correct responses compared with the 13-, 14-, 15-year-olds and with the adults. The right ear advantage was greater in the 7-year-olds than in the 15-year-olds and adult group. At the age of 7 there was lower DPT and FPT scores than in all participants ≥13 whereas the 8-year-olds obtained less correct responses in the FPT than all age categories ≥12. Almost all groups (except for the 7-year-olds) performed better in the DPT than FPT. The test-retest reliability for all tests was satisfactory. The study demonstrated that different CAP have their own patterns of improvement with age and some of them are specific for the Polish population. The psychoacoustic battery may be useful in screening for CAP disorders in Poland.

scholarly journals Two muscular variations in the elbow associated with the anterior interosseous nerve

2021 ◽  
Author(s):  
Łukasz Olewnik ◽  
Bartłomiej Szewczyk ◽  
Nicol Zielinska ◽  
Dariusz Grzelecki ◽  
Michał Polguj
Keyword(s):  
Biceps Brachii ◽  
Clinical Importance ◽  
Ulnar Artery ◽  
Flexor Pollicis Longus ◽  
Main Band ◽  
Anatomical Dissection ◽  
Pronator Teres ◽  
Anterior Interosseous Nerve ◽  
Male Cadaver ◽  
The Right

AbstractThe coexistence of different muscular-neurovascular variations is of significant clinical importance. A male cadaver, 76 years old at death, was subjected to routine anatomical dissection; the procedure was performed for research and teaching purposes at the Department of Anatomical Dissection and Donation, Medical University of Lodz. The right forearm and hand were dissected using standard techniques according to a strictly specified protocol. The presence accessory head of the flexor pollicis longus may potentially compress the anterior interosseous nerve. The present case report describes a rare variant of the ulnar head of the pronator teres, characterized by two independent bands (i.e., two proximal attachments). The main band originates from the coronoid process and the second originates from the tendon of the biceps brachii. This type of attachment could potentially affect the compression of the ulnar artery running between the two bands. Additionally, the accessory head of the flexor pollicis longus was observed, which started on the medial epicondyle; its coexistence with a high division median nerve creates a potential pressure site on the anterior interesosseous nerve.

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