How do you perform safe laparoscopic surgery for transverse colon cancer resection in patients showing type B2 vascular anatomical classification?

Transverse colon cancer resection with lymphadenectomy has shown to cause a lot of technical difficulties, partly due to the variability of the vasculature around the middle colic vessels. However, recently a new classification system has been established. What are the risks of performing colectomy is in patients belonging to Type B2 vascular anatomical class, how can they be minimized, and how can you reduce the patient’s recovery period?

Review our new Laparoscopic Transverse Colectomy procedure now available on the Touch Surgery app to learn how our General Surgery key opinion leader Dr. Atsushi Hamabe describes how to safely perform this procedure.

Key facts:

  • Colorectal cancer is the second most common cancer in women and the third most common in men, worldwide, causing ~694,000 deaths per year. Mortality is greater in less-developed countries, reflecting a poorer survival in these regions.
  • The American Cancer Society estimates that by the end of 2018 ~97,220 new cases of colon cancer will be diagnosed in the United States with ~50,630 deaths.
  • Over the past 10 years, advances in systemic therapy for colorectal cancer has dramatically improved patient outcome. However, surgery remains the definitive treatment modality for localized colon cancer (stage I-III)

Transverse colon cancer resection in patients belonging to Type B2 vascular anatomical class is considered as one of the most rare and most difficult colorectal procedures. Dr. Atsushi Hamabe highly recommends to “preserve the first jejunal vein, prior to the ligation of the middle colic artery.”

Patients belonging to Type B2 vascular anatomical classification.

“In this case, the first jejunal vein runs in front of the superior mesenteric artery and cranial to the middle colic artery, flowing into the superior mesenteric vein. This is an uncommon variation in patients. In such cases, it is important to isolate and preserve the first jejunal vein, prior to the ligation of the middle colic artery.”

Dr. A. Hamabe (Toyonaka Municipal Hospital, Department of Gastroenterological Surgery)

Learn how to avoid injury to the ureter and gonadal vessels.

“During the mobilization of the mesocolon, avoid injury to the ureter and gonadal vessels in the retroperitoneal space by keeping the posterior parietal peritoneum intact”

Dr. A. Hamabe (Toyonaka Municipal Hospital, Department of Gastroenterological Surgery

Mobilized transverse colon ready to be resected.

Understand how to successfully remove the tumor and perform anastomosis extracorporeally using the minimally invasive approach. 

“Grasp the transverse colon and ensure it can be moved comfortably to the umbilical area without causing tension”

Dr. A. Hamabe (Toyonaka Municipal Hospital, Department of Gastroenterological Surgery)

View our new simulation – Laparoscopic Transverse Colectomy – on the Touch Surgery App and test your procedural awareness.