Each surgeon has a preference for his or her approach to right colon surgery through a laparotomy approach. Laparoscopy has not changed those preferences, and there are strong proponents for each approach. So, the author believes that a laparoscopic right colectomy can be safely and efficiently performed by either a medial-to-lateral or a lateral-to-medial approach. This treatise is not intended to argue the case for either approach, but rather to describe the concepts and maneuvers involved in the lateral-to-medial approach.

That being said, the author prefers the lateral-to-medial approach because it allows the surgeon to identify one of the most important structures related to laparoscopic right colectomy’the right ureter’early in the case before any potentially difficult and/or dangerous mesenteric dissection is initiated. In his opinion, this method significantly reduces the stress that the surgeon may have while performing the dissection. Instead of worrying about “where is that ureter?” the surgeon can use that “extra brain power” to focus on the most appropriate extent of the dissection. (Consider the alternative wherein the right ureter is not identified early in the medial-to-lateral dissection, and the surgeon is required to continuously use at least “some” computational energy to be concerned about its whereabouts.) The lateral-to-medial approach is also consistent with the so-called “classical” approach to right colectomy used in open surgery by many surgeons. In fact, when laparoscopic right colectomy was first developed it was the preferred method used by most surgeons (2,3,4,5). A decade later reports describing the medial-to-lateral approach surfaced; reasons for this have been debated but this is not the subject of this material (6,7).