Laparoscopic Right Colectomy for Malignant Disease

Abstract

Laparoscopic right hemicolectomy for malignant disease is a safe and effective approach to achieve an adequate oncologic outcome and decrease perioperative complications. Data from studies comparing open and laparoscopic surgery are presented and compared. Appropriate patient selection and preparation are important in attaining these goals. Experience in open oncologic technique and advanced laparoscopy are mandatory to master difficulties which may occur especially in right hemicolectomy with its multiple anatomic vascular variations. Modifications to the operative technique can facilitate challenging dissections, but the oncologic principles must be followed which comprise complete mesocolic excision and high vascular tie and removal of the specimen with preserved surfaces and no tears or defects. A medial-to-lateral approach is recommended but a primarily lateral mobilization is also feasible. A standardized stepwise approach is presented and illustrated which should facilitate the procedure, improve outcomes and avoid complications. The most frequently reported complication is bleeding which may be harzardous if central vessels like the superior mesenteric vein or artery are affected. By choosing appropriate dissection instruments and carefully handling dissection planes and mesenteric tissue in general, complications will be minimized and the advantages of a laparoscopic approach will be fully accomplished.