Layer-Oriented Lateral Superior Approach for Robotic Right Hemicolectomy: A Novel Embryology-Based Strategy and Initial Clinical Outcomes

Abstract

Background: Complete mesocolic excision (CME) with D3 lymphadenectomy is an oncologically established procedure for right-sided colon cancer; however, the optimal dissection plane and surgical approach remain controversial. We developed a novel layer-oriented lateral superior approach (LSA) that enables the intentional, depth-tailored selection of embryological dissection planes in robotic right hemicolectomy. Methods: This retrospective single-center study included consecutive patients who underwent robotic right hemicolectomy using the LSA between June 2023 and May 2025. The dissection plane was selected according to tumor depth (≤T2 vs. ≥T3). Perioperative and short-term oncological outcomes were evaluated. Results: Thirty-six patients were included. The median operative time was 289 min, and the median blood loss was 10 mL. No intraoperative complications or conversions occurred. Postoperative complications were observed in 6 patients (16.7%), all ≤Clavien–Dindo grade II. The median number of harvested lymph nodes was 31, and main lymph node metastases around the middle colic artery were identified in three patients. Among patients who underwent curative-intent resection (stage I–III), the median follow-up was 16.9 months. The estimated 2-year disease-free and overall survival rates were 92.4% and 84.2%, respectively. Conclusions: The LSA was feasible and safe in this initial series and provides a novel layer-oriented strategy for robotic CME.