Single-port extraperitoneal right hemicolectomy with complete mesocolic -A human cadaveric study.

BACKGROUND

Extraperitoneal access strategies have been successfully applied to left-sided colorectal resections, but their application to right-sided colectomy with complete mesocolic excision (CME) has not been described in accordance with the IDEAL framework. The EXPERTS (EXtraPEritoneal coloRecTal Surgery) with Complete Mesocolic Excision (CME) approach aims to utilise the superior oncological advantages of CME with the safety of extraperitoneal approach to central vascular structures.

METHODS

As part of IDEAL Stage 0 (preclinical development), a structured cadaveric Programme was undertaken to assess the anatomical feasibility, reproducibility and visualisation of critical structures during EXPERTS right hemicolectomy with CME. A total of 11 cadavers were dissected, including nine preserved using the Thiel method and two using fresh frozen preservation. All dissections were video recorded and analysed.

RESULTS

In nine out of 11 cadavers (9 Thiel-preserved and 2 fresh frozen cadavers), consistent identification of key anatomical structures-including the right kidney, duodenum, superior mesenteric artery (SMA), superior mesenteric vein (SMV) and their major branches-was achieved via an extraperitoneal approach. Fresh frozen cadavers demonstrated more variable tissue quality and plane definition. High-quality operative videos were obtained for further analysis.

CONCLUSION

This IDEAL Stage 0 study demonstrates the anatomical feasibility of an extraperitoneal approach to right hemicolectomy with CME and supports progression to assess its safety and effectiveness in a clinical setting.