Right hemicolectomy is applicable to ileocecal cancer, ascending colon cancer and colonic hepatic flexure cancer, and the scope of resection is part of ileum, all ascending colon, part of transverse colon and all lymph nodes in the root area of colonic mesentery and superior mesenteric vessels, which is clinically called total mesenteric resection (CME). The key to achieving radical surgery for carcinoma of the ileocecal region, ascending colon and hepatic flexure of the colon is whether the lymph nodes in the root area of the superior mesenteric artery are cleared. Lymph node dissection in the region of the root of the superior mesenteric artery has certain risks, which may cause tearing of the blood vessels in the region, causing hemorrhage, or damage to the superior mesenteric vessels, necrosis of the small intestine, or even life-threatening. To achieve true right hemicolectomy with total mesenteric resection (CME), the lymph node dissection in the root area of the superior mesenteric artery is a difficult and core part of the operation. Wang Gangcheng, Department of General Surgery, Henan Cancer Hospital At present, the traditional and common clinical surgical approaches are: 1. right hemicolectomy through the lateral peritoneal approach to the colon; 2. right hemicolectomy through the midline approach. Both approaches can achieve total mesenteric resection of the right hemicolectomy. According to the tumor-free principle of tumor resection, I prefer the midline approach for right hemicolectomy because the midline approach can firstly sever the vascular and lymphatic metastatic pathways of the tumor without touching the tumor, which can better achieve the intraoperative tumor-free principle. However, in order to achieve lymph node clearance in the root area of the superior mesenteric artery and vein, the operator always has a feeling of insecurity, and there is always a premonition of the possibility of bleeding and bleeding from the superior mesenteric artery and vein or ascending colonic vessel or gastrocolic vein trunk bleeding or bleeding from the middle colonic vessel, and bleeding from any of the vessels may lead to serious tearing of the superior mesenteric vein and endanger the blood flow of the small intestine. reflux. There is this feeling mainly because it is difficult to grasp the strength of lymph node tissue clearing in the region, if the pulling strength is too large, it is easy to bleed, and the strength is small local tension cannot be reached and clearing is difficult; another reason is that once bleeding occurs, the two traditional methods have limited control over the treatment of local vascular bleeding and it is difficult to stop bleeding. Therefore, even if the operator does not bleed with these two methods of right hemicolectomy, he always has palpitations, like walking in the dark, even if there is no obstacle on the way, he is still careful and tiptoeing, which seriously affects the progress speed of the operation and prolongs the operation time. I introduce below that the three-line phacoemulsification method can thoroughly, safely and tumor-free perform right hemicolectomy (ileocecal cancer, ascending colon cancer and colonic hepatic flexure cancer). Surgical method: 1. Take the root of the superior mesenteric vessels as the core and determine the course of the three lines (see Figure 1). According to the scope of right hemicolectomy, the course of the vessels in the transverse colonic mesocolon returning to the superior mesenteric vessels was taken as the first line; the course along the horizontal part of duodenum to the superior mesenteric vessels was taken as the second line; the course along the ileocolonic vessels returning to the superior mesenteric vessels was taken as the third line. 2. Break the colon and colonic vascular arch. According to the site and size of the tumor, select the disconnection point for resection of the transverse colon, follow the direction of the first line, disconnect the transverse colon, the vascular arch, the colonic mesentery to the root of the superior mesenteric vessels, and stop the operation in this direction line.3. Separate the external fascia of the horizontal part of the duodenum from the mesenteric gap of the right hemi-colon. The second line (i.e., the direction of the horizontal part of the duodenum) is followed to separate the external duodenal fascia from the right hemi-colonic mesenteric gap to the root of the superior mesenteric vessels, and the operation is stopped.4. The third line is followed to break the small intestine, the marginal arch vessels, the small intestinal mesentery, and the ileocolic vessels to the root of the superior mesenteric vessels. 5. The gastrocolic ligament and the collateral right colonic vessels are broken. The gastrocolic ligament was severed along the right vessel of the gastric omentum to the right, and the collateral right colonic vessels were disconnected and ligated. 6. Lymph nodes of the superior mesenteric root were cleared. The four fingers of the left hand enter the root of the superior mesenteric vessels in the direction of the second line and come out from the gap of the third line, while pulling the middle colonic vessels and the mesentery downward, so that the entire tissue and lymph nodes of the superior mesenteric vessels region are controlled in the left hand (see Figure 2). According to the size of the lymph nodes in the region and the difference of tissue gap between different types of individuals, the operator can appropriately grasp the tissue tension of local clearance and the strength of scissors or electric knife, even if bleeding occurs, the operator can then control the hemostasis, so that the heart does not panic, the knife is not disorderly, and the knife is free and targeted (see Figure 3). The main advantages of the method: 1. Clear surgical thinking. After the whole surgical procedure is given modularity and treated in the direction of three lines, the visual field is clear and the idea is clear. 2. It is more in line with the principle of whole tumor resection. The scope of resection is basically centered on the tumor, and the surrounding tissues of the tumor are firstly separated, and the tumor is basically not touched and squeezed during the operation, while the vascular and lymphatic metastatic pathways of the tumor are firstly separated. 3. High safety. The three-line single direction surgery operation only progresses to the vicinity of the root of the superior mesenteric vessels and stops the operation to avoid uncontrollable tearing and bleeding when the root of the superior mesenteric vessels is not completely free. When all three lines of operation are completed, which means that the area around the root of the superior mesenteric vessels is basically completely free and clutched in the left hand, then lymph node removal is performed, which is very controlled locally and easy to handle even if bleeding occurs.4. Avoid intraoperative duodenal injury. Intraoperative duodenum has been separated from other tissues on the second line, while being protected under the back of the left hand, avoiding duodenal injury.5. Fast operation time. The operation time can be significantly shortened by following the method step by step, without purposely pursuing the speed of the operation, mainly because the operation is procedural and modular, and there is no intraoperative turning over and over to view the surrounding tissues. 6. Lymph node dissection is thorough. Because of the high surgical safety, controlled risk and good visual field exposure, it is obvious that the fundamental mesenteric lymph nodes can be easily cleared. Intraoperative issues that need attention: 1. Avoid the pulling of the intestinal tube on the root of the superior mesenteric vessels. When the intestinal tube is discharged, it is easy to ignore the fall and pull of the intestinal tube, and the pull leads to bleeding of the root of the superior mesenteric vessels.2. When dealing with the paramedian right colonic vein, be careful not to tear the gastric junctional trunk vein, which can easily extend to the root of the mesenteric vein.3. When the root of the superior mesenteric vein bleeds, remember not to blindly use a vascular clamp to stop the bleeding, which can easily lead to more aggressive bleeding of the superior mesenteric vein. The best method is to compress the vein temporarily, and the bleeding will stop after the vein is compressed for a period of time. When the treatment is finished in the trilinear direction, the specimen is removed and the bleeding point is treated again. Figure 1 schematic diagram, red arrows represent the three lines of surgical operation direction Figure 2. After operating near the root of the mesenteric vessels in all three lines of direction, the transverse colonic mesentery is pulled downward, and the whole right hemicolectomy and the transverse colonic mesentery to be resected are clutched in the left hand Figure 3. Lymph node dissection of the root of the superior mesenteric vessels is performed under the control of the left hand