The terminal ileal vein approach: a novel and simple technique for locating the superior mesenteric vein and en bloc resection of the ileal mesentery in laparoscopic right hemicolectomy.

Abstract

Laparoscopic right hemicolectomy (Lap-RHC) presents technical challenges due to the complex vascular anatomy of the mesentery, which increases the risk of intraoperative bleeding and complicates surgical navigation. Accurate identification of the superior mesenteric vein (SMV) is crucial for maintaining surgical safety and achieving optimal oncological outcomes. To address these challenges, this study proposes the terminal ileal vein (TIV) approach, a novel technique designed to facilitate precise SMV identification and enable en bloc resection of the ileal mesentery while preserving mesenteric integrity. This retrospective cohort study evaluated a novel TIV approach compared to the traditional ileocolic vascular pedicle (IVP) approach for SMV identification and en bloc mesentery resection in patients with right-sided colon cancer. A total of 196 patients underwent Lap-RHC between 2022 and 2023, with 67 patients matched by propensity score included in both groups. The TIV approach involves initiating dissection at the TIV to accurately locate the SMV and facilitate en bloc resection of the ileal mesentery. In the balanced cohort, statistically significant differences were observed between groups regarding operation times (186 [120-299] vs. 210 [146-375] minutes, p = 0.001) and intraoperative blood loss (50 [20-400] vs. 70 [20-600] mL, p = 0.033). Differences were also found for time to urinary catheter removal (1 [1-3] vs. 2 [1-5] days, p = 0.012) and postoperative hospital stays (6 [5-12] vs. 7 [5-15] days, p = 0.006). The calculated importance proportion of the TIV approach related to these perioperative variables was between 15 and 25%. In this retrospective cohort, the TIV approach demonstrated reproducible entry into the mesenteric dissection plane and was accompanied by perioperative outcome differences that may reflect technical simplification. Further prospective investigation is needed to determine its clinical utility.