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Last updated: 17-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
In short
A right hemicolectomy for cancer removes the right colon inside its fatty envelope, the mesocolon. That envelope holds the lymph nodes where the cancer spreads first.
CME means the envelope comes out whole, like a sealed packet, and its blood vessels are tied where they start. This takes out the central nodes as well.
Keyhole surgery is the usual route for this operation. The robot does the same cancer operation, and it helps most with stitching inside a narrow or heavy abdomen.
CME is one part of colon cancer surgery. The full picture, from staging to choosing the operation, is on the main robotic colon cancer surgery in Ahmedabad page.
The right colon is the first part of the large bowel. It starts at the caecum, low on the right side, and runs up to the bend under the liver. It then turns across as the transverse colon.
The colon does not float free. It is wrapped in a thin sheet of fat called the mesocolon. The arteries, veins and lymph nodes of the colon all run inside this sheet. The sheet ends at the two main vessels of the gut, the SMA and the SMV.
This operation is used for cancers of the caecum, the rising colon, the bend under the liver and the first part of the transverse colon. It is a cancer operation. Benign problems such as Crohn’s disease or diverticular disease need a simpler operation, without the deep node removal.
Lymph nodes lie in rings along each artery, from the bowel wall back to the main vessel. Surgeons name these rings D1, D2 and D3.
| Level | Where the nodes sit | Removed in CME? |
|---|---|---|
| D1 | On the bowel wall, close to the tumour. | Yes. |
| D2 | Along the named artery that feeds that part of the colon. | Yes. |
| D3 | At the root of that artery, where it leaves the main vessel. | Yes. This is the central ring. |
CME with D3 removes all three rings in one piece, still inside the envelope. Nothing is cut through on the way.
The pathologist looks at the surface of the removed specimen. A smooth, unbroken envelope means the surgeon stayed in the right layer. A torn envelope may leave cancer cells behind.
An intact envelope and a good number of nodes give a reliable stage. They also lower the chance of the cancer coming back in the same area.
A large trial from China compared CME with D3 against a smaller node removal. Fewer cancers came back after CME, and complications were no higher. A European trial found more specimens with a clean, whole envelope after CME. These are the results the note relies on.
The node report also guides what comes next. It decides whether chemotherapy is advised after surgery.
At the root of the right colon, several veins join into a short trunk in front of the pancreas. It is called the gastrocolic trunk. It is short and thin-walled, and it tears easily if pulled.
Its pattern differs from person to person. So your surgeon reads the vein phase of your CT before the operation and notes the pattern. Unusual arteries to the liver are looked for too.
The vessels are found and tied first, before the colon is freed. This order keeps the dissection clean and lowers the chance of serious bleeding.
Both routes do the same CME with D3. The difference lies in the tools and in who gains most.
| Point | Keyhole (laparoscopic) | Robotic |
|---|---|---|
| The cancer operation | CME with D3. | The same CME with D3. |
| Usual role | The standard route for a planned operation. | Chosen especially for a heavy build, a deep mesentery or a narrow abdomen. |
| Small cuts | Usually five small ports. | Four robotic arms in a line, plus one helper port. |
| Stitching the join inside | Possible, with staplers and keyhole stitching. | Easier, because the tools bend at the wrist. |
| Cost | Lower. | Higher. |
In a wider abdomen, keyhole surgery matches the robot. The care taken in the envelope and at the vessels matters more than the machine. Either route can change to open if the layer is lost or bleeding needs control. Changing early is safer than changing late.
After the colon is removed, the small bowel is joined to the remaining colon. Today this join is usually made inside the abdomen, with keyhole or robotic tools.
Compared with a join made outside, trials show a faster return of bowel movement and less pain. The hospital stay is shorter, and cancer results are the same. One trial from Europe, called COLOR IV, settled this question.
The specimen then comes out through one small cut, low on the abdomen near the bikini line. A plastic sleeve protects the wound. This cut has a lower chance of a later hernia than a cut through the navel.
Most people follow a fast-recovery pathway. There is usually no nose tube and often no drain.
People treated for cancer usually continue blood-thinning injections at home for about four weeks. This lowers the chance of clots.
Your own figures are discussed at the consent meeting.
No. It is the way a right hemicolectomy for cancer is done. The colon comes out inside its whole envelope, with the central nodes.
No. Both routes do the same CME with D3. The robot mainly helps with stitching in a narrow or heavy abdomen.
Usually not. The bowel is joined in the same operation. A stoma is needed only rarely, for an unexpected finding.
No. CME is a cancer operation. Benign disease needs a simpler bowel removal, without the deep node work.
The surgeon checks the pattern of the veins near the pancreas. Knowing it ahead makes the vessel work safer.
Colon cancer surgery at this centre is covered on the robotic colon cancer surgery page. The operation itself is on the robotic right hemicolectomy page. For questions before you travel, call +91-63590-11009.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of scans and biopsy reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Has your plan for right colon cancer been written as CME or D3? The colonoscopy, biopsy and CT reports can be sent ahead on WhatsApp, so the visit starts with them already read. The operation is decided at the consultation, after examination. Call +91-63590-11009 Send reports before your visit
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