GONG emicolectomia dx (D3+CME) per cancro del colon

hi good morning or good afternoon it depends on the place

hi professor my name is umberto grandi and i'm here on behalf of professor giorgio palestini in

our usual appointment in during this period well it looks like it's something different

respect the other years because we now we have an emergency of because of the covet and so we

are online we are not in rome i'm here in my hometown that's a very old city in the northern

part of italy anyway uh it looks like it will be a very interesting the program is so huge

is so interesting i i know what you are going to do but as you are online with so many people

looking at your your performing operation can you introduce yourself and

tell them that you are going to talk about this gastrectomy and so on some

details on the patient and whatever you would like to say about your wonderful

operation I know we are so so expert about this can you go on please

Thank you so much.

Sure, sure, sure.

So first, we introduce the patient's history first, okay?

And this patient is male.

right hand me, correct me, D3 plus CM. It means that D3 field as completely as possible keeps the mesentery as completely as possible excision.

Okay, thank you.

And today, we do the D3 plus CME, and tomorrow, we're going to do the D2 plus CME for gastric cancer.

Both operations based on a new anatomy we call the membrane anatomy.

The membrane anatomy means feeding structure and pathological events only stay in the mesentery.

The question, the key point is we should know where is the mesentery it is.

okay okay so professor can you show us the trocar placements and maybe we have an outer

view of the of the patient is it possible okay here you see this is a scope yeah and here is

This is my sonical root, K9, right here, and here is my acetonut, okay?

thing i'm here with you anyway you have to know we are online so we there is a lot of public

looking at your at your wonderful procedure

to separate try to work colon

are somehow, the images are not great in this moment, they are all pixelized, I don't know

why, but anyway we are able to follow your procedure, Professor.

I don't think it's a problem of speed, I mean, not here in Ravenna for sure, and I'm quite

sure as well you are in a good speed connection.

Can you tell us again what you are going to do now?

Yeah, the operation we do today is what we call the ribosomal colactomy D3 plus CME.

So, first we go to separate the right vasotelary of the colon from its bell.

And until to the SMV and SMA to make D3 dissection.

The operation we called make the traditional D insert, traditional CME didn't tell us at which one, at which of the field.

so here you are can you tell us I'm so sorry to bother you professor but can

you tell us what have you done in the last 15 minutes we couldn't we couldn't

Yeah, so we will repeat again. In a part of the 15 minutes, we'll start from the SMB and SMA

disruption and keep the mesentery as completely as possible at the D3 level.

So, keep the ligation and the root of the blood vessel at a decent rate.

Okay?

Okay.

I don't think there's any reaction from the audience.

It's a secret.

I think there's a question from the audience.

It's really good.

We can hear you.

The images are not very...

Here we are managing the arrow,

the triangle arrow

to the 3-2.

It's the middle

root 2 is the middle column

column Venn and mid-three is associated right column Venn on a heavy truck.

When you make the ligation at tri-root aero and keep the mesentery as completely as possible,

we call the operation is D2 plus CMZ.

D3, I'm sorry.

no any serious complication. The key point of this operation is to recognize the anatomy we call the membrane anatomy.

I'm sorry, we cannot take full advantage of your skill because of the images that are not perfect. I'm so sorry.

Even though our speed connection is great and I don't know why.

The 1.0 map, we call that organ anatomy. 2.0 map, we call that blood vessel anatomy.

We call that 3.0 map, upgrade map. We call that membrane anatomy.

From the membrane, most of the aerial is block by block, symbolized by the membrane.

If we realize this, the operation is different.

So, I visited Italy several times.

We made a discussion,

discussing a member like me with Dr. Ugo,

Professor Di Giulia.

So, I hope we found

some chance when the COVID-19 passed,

But, we are not in again to discuss the membrane anatomy again.

In fact, the nose obviously stays in the masonry.

The problem is we don't know where is the masonry.

If we understand where is the masonry,

everything will become simple, safe, and benefit of oncology.

The tradition is to prevent too much bleeding during the operation.

If we understand where the mass of gastric is,

the operation will become much more clear than before.

We hope most surgeons can observe tomorrow's operation of the B2 plus CME for cancer cancer

and give us some advice, suggestions, questions, and even arguments.

Can you tell me again how many of CME in right hemicolectomy have you performed so far?

How many?

More than 500 cases.

Great experience.

Best components.

Yeah.

But in China, first, more common is cancer.

And this operation, I think, is more common in Europe, right?

Yes, you are right.

That's quite normal in Italy.

Yeah, that's quite normal, yeah.

So, for Italy, for Europe and North America,

T3 plus TME is more important than in China.

Because in this way, you always from block to block make everything clear.

Otherwise, if you use the traditional anatomy,

to the superior mesenteric vein,

and then the ileocolic vessels were divided

as so close to the superior mesenteric vein.

And after exposing the mesocoling interface,

he performed a wide separation between the pancreatic head

and the transverse colon.

to see your procedure on the last minutes

colleague, but I intervene directly from the congress.

I can't hear anything.

Yes?

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SME, SMB, SMA. Make ligation at each blood vessel root to make sure it's a D3 dissection.

And when we separate the mesentery with the bed, we keep it in the correct plan. So we

We make sure CME, that's why we call that D2 plus CME.

And then we make a small incision,

make an anastomosis, thank you.

Okay, thank you so much.

Then tomorrow we will show, present a life surgery

for D2 plus CME for gastric cancer.

just because we had some issues some technical issues anyway i thank you so much as well as

your colleagues and all your operating room staff for staying with us in this strange year

due to covid thank you so much professor thank you okay thank you thank you very much