title: Dynamic article: surgical anatomical planes for complete mesocolic excision and applied vascular anatomy of the right colon.
abstract: BACKGROUND
  Lower local recurrence rates and better overall survival are associated with complete mesocolic excision with central vascular ligation for treatment of colon cancer. To accomplish this, surgeons need to pay special attention to the surgical anatomical planes and vascular anatomy of the colon. However, surgical education in this area has been neglected.
  
  
  OBJECTIVE
  The aim of this study is to define the correct surgical anatomical planes for complete mesocolic excision with central vascular ligation and to demonstrate the correct dissection technique for protecting anatomical structures.
  
  
  METHODS
  Macroscopic and microscopic surgical dissections were performed on 12 cadavers in the anatomy laboratory and on autopsy specimens. The dissections were recorded as video clips.
  
  
  METHODS
  Dissections were performed in accordance with the complete mesocolic excision technique on 10 male and 2 female cadavers. Vascular structures, autonomic nerves, and related fascias were shown. Within each step of the surgical procedure, important anatomical structures were displayed on still images captured from videos by animations.
  
  
  RESULTS
  Three crucial steps for complete mesocolic excision with central vascular ligation are demonstrated on the cadavers: 1) full mobilization of the superior mesenteric root following the embryological planes between the visceral and the parietal fascias; 2) mobilization of the mesocolon from the duodenum and the pancreas and identification of vascular structures, especially the veins around the pancreas; and 3) central vascular ligation of the colonic vessels at their origin, taking into account the vascular variations within the mesocolonic vessels and the autonomic nerves around the superior mesenteric artery.
  
  
  CONCLUSIONS
  The limitation of this study was the number of the cadavers used.
  
  
  CONCLUSIONS
  Successful complete mesocolic excision with central vascular ligation depends on an accurate knowledge of the surgical anatomical planes and the vascular anatomy of the colon.
authors.affiliation: 1Department of Anatomy, Faculty of Medicine, Ankara University, Ankara, Turkey 2Council of Forensic Medicine, Istanbul, Turkey 3General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Halil İbrahim
authors.initials: Hİ
authors.lastname: Açar
authors.forename: Ayhan
authors.initials: A
authors.lastname: Cömert
authors.forename: Abdullah
authors.initials: A
authors.lastname: Avşar
authors.forename: Safa
authors.initials: S
authors.lastname: Çelik
authors.forename: Mehmet Ayhan
authors.initials: MA
authors.lastname: Kuzu
mesh_terms: D001158:Arteries / Q000033:anatomy & histology / Q000601:surgery; D002102:Cadaver; D044683:Colon, Descending / Q000033:anatomy & histology* / Q000098:blood supply / Q000601:surgery*; D044684:Colon, Transverse / Q000033:anatomy & histology* / Q000098:blood supply / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D004210:Dissection / Q000379:methods; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D010525:Peripheral Nerves / Q000601:surgery; D014656:Vascular Surgical Procedures; D014680:Veins / Q000033:anatomy & histology / Q000601:surgery; D014741:Video Recording