title: A medial to lateral approach offers a superior lymph node harvest for laparoscopic right colectomy.
abstract: OBJECTIVE
  Studies have shown improved survival with increasing amounts of harvested lymph nodes. The purpose of this study was to evaluate two laparoscopic techniques to right colectomy, laparoscopic medial to lateral (MtL) approach and laparoscopic lateral to medial (LtM) approach, in patients undergoing a right colectomy for either endoscopically unresectable polyps or carcinoma and determine which technique offers the optimal lymph node harvest.
  
  
  METHODS
  Patients that underwent a laparoscopic right colectomy over a 5-year period were identified. Charts were reviewed with regards to demographics, surgical approach, length of stay (LOS) and number of lymph nodes harvested. Variables were statistically analyzed and outcomes compared between the two groups. A p value of less than 0.05 was considered statistically significant.
  
  
  RESULTS
  Two hundred thirty-three patients underwent a laparoscopic right colectomy over a 5-year period for endoscopically unresectable polyps or carcinoma. Seventy-nine patients underwent a MtL approach and 154 patients underwent a LtM approach. When comparing the two groups, there were more females in the MtL group relative to the LtM group (78% vs 66%; p = 0.0015). When the outcome of number of lymph nodes harvested was examined, there was a significantly larger number of nodes harvested in the MtL (median = 24) approach compared to the LtM approach (median = 19; p = 0.0002). LOS was similar between the MtL and LtM group (median 4 days for both).
  
  
  CONCLUSIONS
  The laparoscopic MtL approach to right colectomy yields a larger lymph node harvest compared to the laparoscopic LtM approach.
authors.affiliation: William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI, USA. colorectalsurg@outlook.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Honaker
authors.affiliation: William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Scouten
authors.affiliation: William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI, USA.
authors.forename: Jordy
authors.initials: J
authors.lastname: Sacksner
authors.affiliation: William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Ziegler
authors.affiliation: William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Wasvary
mesh_terms: D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D016896:Treatment Outcome
keywords: Ascending colon cancer; Medial disection; Nodal harvest