Techniques of laparoscopic right hemicolectomy: Cancer and Crohn disease

Ass. Prof. Zdravko Perko

Indication

• Cancer / carcinoid• Crohn disease• Cecal tumors• Cecal necrosis ....

Trocar positioning

• based on the experience and preference of the individual surgeon

• RIGHT HEMICOLECTOMIES– four trocars (50%), 3 trocars (30%), 5

trocars (20%)

• specimen extraction– at the site of the umbilical trocar, subcostal

incision, upper medial incision– Crohn – right lateral (split) incision

Right colonpatient position - op setup

Trocar position

– At the umbilicus 10-12mm trocar is placed

– A 10mm trocar is placed suprapubically– The epigastric region by 70% of authors– Some experts place a 5mm trocar at the left

iliac fossa or at the right subcostal space.

Trocar position

Right colon - trocars

Right / Transverse colonpatient position - op setup

Right / Transverse colontrocar placement

Right colon - procedures

Crohn diseaselap assisted procedures

Stricturoplasty

Anatomical features

Right colon carcinoma

Right colon carcinoma

Right colon - exposure

Right colon – medial approach

Right colon – anatomical relationships

Right colonanatomical relationships

Right colon – anatomical relationships

Right hemicolectomy

• Medial / lateral approach• Blood vessels• Urether / duodenum injury

• Ileocolic artery transsection– Right / medial colic art. transection

• Extracorporeal anastomosis

Extracorporeal anastomosis

• Incision– Upper medial, umbilical, subcostal

• Final dissection– Vessels transection, great omentum

• Anastomosis– End-to-end, end-to-side, side-to-side– Suture mesenteric gap– drainage

Postoperative course

• No NGT

• Liquid diet on the day of op• Encourage mobilisation• .....