Pancreas-guided C-shaped surgical procedure: a safer and more efficient procedure for laparoscopic left hemicolectomy in obese patients

The surgical risk is higher for obese patients undergoing laparoscopic left hemicolectomy. To enhance the surgical safety and efficacy for obese patients, we have innovatively integrated the advantages of various surgical approaches to modify a pancreas-guided C-shaped surgical procedure. The safety and quality were assessed through a retrospective analysis. Colon cancer patients who underwent laparoscopic left hemicolectomy were categorized into two groups, C-shaped group and Medial-to-lateral group. Baseline data, operative safety indices, operative quality indices and learning curve were subjected to statistical analysis. The complete mesocolic excision rate and R0 resection rate were 100% in both groups. In terms of surgical safety, C-shaped group experienced significantly less blood loss (50(20) mL vs. 50(50) mL, p = 0.002), shorter total operative time (252.65 ± 50.43 min vs. 280.12 ± 70.45 min, p = 0.004) and no organ damage occurred. All patients were classified into four BMI grades (I: BMI < 18.5 kg/m²; II: 18.5 ≤ BMI < 24 kg/m²; III: 24 ≤ BMI < 28 kg/m²; IV: BMI ≥ 28 kg/m²). The total operative time and estimated blood loss were significantly lower in obese patients (BMI grade III and IV) of C-shaped group. In addition, intra-group analysis further confirmed that this modified surgical technique could effectively enhance safety and efficiency for obese patients. Learning curve analysis revealed a significant reduction in total operative time after the completion of 20 surgeries. Utilization of the pancreas-guided C-shaped surgical procedure in obese patients ensures reliable surgical outcomes and significantly increases safety and efficiency. In addition, it is easier to learn and master.