V38 - Mastering the Planes: Laparoscopic Left Hemicolectomy with Complete Mesocolic Excision

Saturday, May 9, 2026

On-Demand

Video Presentation(s)

Hermann Kessler, MD PhD (he/him/his)

Professor
Cleveland Clinic
Cleveland Clinic
Cleveland, OH, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

Metincan Erkaya, MD

Clinical Research Fellow
Cleveland Clinic Digestive Diseases & Surgery Institute
Cleveland Clinic
Cleveland, OH, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
Christopher Prien, MD, MS

Colorectal Surgery Fellow
Cleveland Clinic
Cleveland Clinic
Cleveland, OH, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Senior Author(s)

FD

Florentina Dermuth, MD (she/her/hers)

Research Fellow
Cleveland Clinic, Department of Colorectal Surgery
Cleveland Clinic, Ohio
Cleveland, OH, United States

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

CME Eligible

Purpose/Background: Complete mesocolic excision (CME) with central vascular ligation represents the oncologic gold standard for colon cancer surgery, ensuring optimal lymphadenectomy, preservation of peritoneal planes, and thus, minimizing locoregional recurrence. This video demonstrates a standardized laparoscopic left hemicolectomy with CME, emphasizing precise dissection along embryological planes and critical technical nuances for safe and effective performance.

Methods/Interventions: Following preoperative endoscopic tattooing and bowel preparation, the patient is positioned in modified lithotomy with variable Trendelenburg tilt. A medial-to-lateral dissection approach is utilized. The inferior mesenteric artery and vein are identified and ligated centrally at their origins. Dissection continues in the avascular embryological planes with identification and preservation of the left ureter, gonadal vessels, and hypogastric plexus. The splenic flexure is mobilized completely using combined medial and lateral approaches to ensure a tension-free anastomosis. After specimen retrieval via a mini laparotomy, an end-to-end colorectal anastomosis is fashioned using double-stapling technique, with intraoperative endoscopic assessment for perfusion and leaks.

Results/Outcomes: This video provides a detailed, stepwise demonstration of laparoscopic left hemicolectomy with CME, emphasizing the critical anatomical landmarks and operative strategies required for safe and oncologically sound surgery.

Conclusion/Discussion: The case highlights mastery of mesocolic plane dissection, and high vascular ligation. Through high-definition visualization and clear didactic narration, the video serves as a comprehensive teaching tool for trainees and practicing surgeons aiming to refine their understanding of embryological planes and CME principles. Adherence to these principles - precise identification of vital structures, systematic mobilization, and tension-free reconstruction - enhances oncologic safety and minimizes postoperative complications.