title: New approach for laparoscopic surgery of the right colon.
abstract: BACKGROUND
  In patients in whom the ventral aspect of the root of the mesentery was obscured by the adherent greater omentum, laparoscopic surgery is usually abandoned. To forcefully loosen the adhesions by a laparoscopic maneuver may cause inadvertent intestinal injury. We describe a procedure, named the 'retromesen teric approach', which enables a safe laparoscopic right-sided colic operation in such circumstances.
  
  
  METHODS
  From 2000 to 2003 in our institute, a laparoscopic right-sided colic operation was performed in 21 patients in whom the ventral aspect of the root of the mesentery was obscured by the adherent greater omentum using the retromesenteric approach (RMA; n = 16) and a conventional approach (CA; n = 5). We reviewed the medical records for the operative duration, intraoperative blood loss, conversion rates and postoperative complications.
  
  
  RESULTS
  The duration of operation in the RMA group ranged from 75 to 120 (median 95) min, which was shorter than that in the CA group (p < 0.05). Perioperative bleeding in the RMA group ranged from 0 to 115 (median 30) ml, which was smaller than that in the CA group (p < 0.05). No conversion and no postoperative complications were noted in the both groups.
  
  
  CONCLUSIONS
  Our new technique, in which the right colon and the ileum are dissected and lifted en bloc from the retroperitoneum, is safe and useful for laparoscopic right-sided colic operation.
authors.affiliation: Department of Surgery, Kashiwa Hospital, Jikei University School of Medicine, Kashiwa, Chiba, Japan. kawahide@jikei.ac.jp
authors.forename: Hidejiro
authors.initials: H
authors.lastname: Kawahara
authors.forename: Katsuya
authors.initials: K
authors.lastname: Hirai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: Yoji
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D003106:Colon / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*