Retroperitoneal Approach for Total Colectomy in Minimally Invasive Treatment of Synchronous Multiple Colon Cancer.

Abstract

The retroperitoneal approach is an innovative, minimally invasive technique that may benefit patients with colorectal cancer who have significant comorbidities such as cardiovascular disease, obesity, or extensive intra-abdominal adhesions. We present a novel retroperitoneal approach for the minimally invasive surgical treatment of synchronous multiple colon cancers. An interfascial dissection through the retroperitoneal space was performed on the left side in the medial direction. The left ureter and gonadal vessels served as the primary landmarks. The inferior mesenteric vessels were identified, clipped, and cut. The horizontal portion of the duodenum served as the cranial landmark for dissection. Dissection continued medially through the embryonic layers to identify the roots of the ileocolic artery and vein. The vessels were exposed to the surrounding tissue, clipped, and cut. Laparoscopic mobilization of the entire colon was performed. The operation lasted 510 minutes, with the retroperitoneal step requiring 205 minutes. Total blood loss was 200 mL. Postoperative pain intensity was low, and recovery was uneventful. The patient was discharged on postoperative day 7. The retroperitoneal approach appears to be a feasible and minimally invasive option for total colectomy in selected patients with multiple synchronous colon cancers. Further studies are warranted to assess the safety, reproducibility, and long-term oncologic outcomes. See New Technology Report Video .