No. As long as that segment of colon comes out safely, I believe that the approach doesn't matter and it's up to personal preference. 

agree

I think whatever the approach , a safe and complete resection , which will facilitate proper identification of the important structure  like the ureters and the nerve/plexus is what is actually needed. In laparoscopic approach the camera offers a better view, that enables medial dissection much easily.While in the open approach the white line is better accessible  to the operating surgeon. However we need to find if there is sufficient documented evidence.

I agree completely with Dr Zachariah, but from oncologic point of view dont you think that in medial-to-lateral approach the feeding vessels can be ligated earlier in the operation according to the oncologic dogma. I am interested are there any data supporting this statement?

 I gave up lateral to medial approach for leftsided resections 20 years ago after a spell in Tokyo observing rectal cancer surgery and laparscopic surgery with jaff milson in NY. Saying that I think person preference does have a strong part to play. I like medial to lateral because of the plane delineating the superior hypogastric plexus but good surgery is good surgery however its done.  I dont think there is any robust data to help us here

Technically both approaches are good as long as the affected portion of colon was not handled.In Rt colonic resections ileocolic vessels can be ligated easily like lateral mobilisation.My preference has been start the dissection openinig the Gastrocolic ligament at mid point of Tr colon medial to middle colic vessels.This has found to be very easy and oncological principles are not violated.

@ Dr Reddy- good  techical tip

I was doing ligation of vessels as the first step and  mobilisising the colon latero-medially.

The lateral-to-medial approach in open colectomy is useful, in some cases, for initial mobilization of the colon. When the colon comes out safely, the medial-to-lateral approach is prefferable  for High ligation of the vessels and identification of the ureters and hypogastric nerves. Thus, in open colectomy the combination of the lateral-to-medial approach with medial-to-lateral is useful.     

Lateral to medial approach for colectomy whether open or laparoscopic is an essential technique to master if in some cases medial to lateral approach is not possible or feasible. A colorectal surgeon or any surgeon should always have a plan B if his plan A does not work.

I totally agree with dr Tsimoyannis. We have to respect the basic priciples of oncologic surgery and individuate clearly embriologic planes in order to avoid organ injuries. I think that medial to lateral approach may be superior compared to the lateral-medial in terms on identification and separation of toldt's fascia from Gerota. Also individuation of urethers is easier. Naturally the bulk of the tumor makes the difference...

I agree with virtuually every one however, I dont think there is any true scientific data with regards to handeling cancers. If we think on a cell biological level than any shed tumour cells will have or retain the genetic defects to; Invade the supramucosal defence barrier or serosal peritoneum, translocate across connective tissue,  adhere to the mucosa,  invade the mucosa, cross the submucosa, and then have the neccassary angio related mutations or deletions for transcoelomic or lumen spread. thus transcoelomic spread and synchronous luminal disease may infact be more or a local manifestation of  systemic disease dure to local neovasculature etc. It is one of those questrions in cancer cell biology that remains under debate

Great discussion and good tips. I believe both methods must be learnt by surgeon in developing countries where most tumors seen are big necessitating combine approach without violating oncological principle