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Laparoscopic Technique for Right Colectomy

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Abstract

Laparoscopic colectomy has become an accepted approach to colon resection. Compared with open colectomy, the laparoscopic technique is associated with equivalent long-term survival but shorter hospital stays, reduced analgesic requirements, improved cosmesis, and earlier resumption of a normal diet. Notably, right hemicolectomy is an appropriate procedure to perform laparoscopically because it lends itself to a standardized, reproducible technique. In this chapter, we discuss our approach to laparoscopic right colectomy, clearly outlining each step and the necessary considerations.

Keywords

  • Colon cancer
  • Laparoscopic colectomy
  • Technique

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Correspondence to Andrew Russ M.D. .

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In this video, the surgeon demonstrates his approach to laparoscopic right colectomy. (MP4 69808 kb)

Key Operative Steps

Key Operative Steps

  1. 1.

    The patient is positioned and ports are placed.

  2. 2.

    The patient is rotated to left side down and placed in Trendelenburg position.

  3. 3.

    The omentum is placed over the transverse colon into the upper abdomen and the small bowel is moved to the left side to give adequate operative space.

  4. 4.

    Dissection and division of the ileocolic pedicle, protecting the ureter and duodenum.

  5. 5.

    Perform a medial-to-lateral dissection of the colonic mesentery.

  6. 6.

    Mobilize the hepatic flexure.

  7. 7.

    Mobilize the terminal ileum off the retroperitoneum.

  8. 8.

    Confirm full mobilization of the right colon to the midline.

  9. 9.

    Divide the right branch of the middle colic artery before the specimen is exteriorized.

  10. 10.

    Extension of the umbilical incision, placement of a wound retractor, and exteriorization of the specimen.

  11. 11.

    Extracorporeal resection and anastomosis.

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Delaney, C.P., Ponsky, J.L., Russ, A. (2015). Laparoscopic Technique for Right Colectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_16

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_16

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