10.109GS Laparoscopic Right Hemicolectomy: A Reproducible Operation that Follows Strict Oncologic...

TITLE: Laparoscopic Right Hemicolectomy: A Reproducible Operation that Follows Strict Oncologic Principles

Introduction: We present the video of a single-incision laparoscopic right hemicolectomy performed in an obese patient with a large cecal polyp not amendable to endoscopic resection.

Methods and Procedure: A SILS port was used for the operation. We utilized a 5-mm flexible tip laparoscope, one articulating grasper, one straight grasper, and a LigaSure clamp. All the steps of conventional laparoscopic right hemicolectomy were followed.

First, the ileo-colic pedicle was dissected medial-to-lateral. Duodenum was identified and preserved. Ileo-colic vessels were divided by using an EndoGIA vascular stapler. Then, the greater omentum was dissected away from the transverse colon by using blunt dissection and the LigaSure. Hepatic flexure was mobilized. Gentle traction was used to separate mesocolon away from retroperitoneum. Then, lateral attachments of the cecum and ascending colon were divided. Pelvic attachments of the cecum and terminal ileum were subsequently separated. The entire right colon was now dissected and mobilized. The right ureter, kidney, and duodenum were clearly seen. The incision was enlarged and bowel was extracted through a wound protector. The entire specimen was now exteriorized. Conventional side-to-side, functional end-to-end stapled anastomosis was performed. The incision was closed.

Results: Patient's postoperative recuperation was unremarkable. Total incision size was 3.5cm. The final pathology report revealed villous adenoma without evidence of invasive malignancy with 20 negative lymph nodes.

Conclusions: The technique described herein allows for performance of laparoscopic right hemicolectomy through a single small incision by using commercially available instruments. All surgical and oncologic principles were followed closely, which makes for a safe and reproducible operation.

Authors: Eugene Rubach, MD, Matthew Ostrowitz, MD, George DeNoto, MD, Gary Gecelter, MD

St. Francis Hospital; North Shore Long Island Jewish (LIJ)-Health System, New York

Category:

Science & Technology

Tags:

• SLSEE10
• SocietyLapSurgeons
• 'society
• of
• laparoendoscopic
• surgeons'
• SLSGeneralSurgery
• SLSEducation
• laparoscopic
• laparoscopy
• SLS
• SLSTV
• SLSColectomy
• SLSHemicolectomy
• hemicolectomy
• colectomy
• SLSSILS
• SILS
• 'single
• incision
• surgery'
• SLSCancer
• Cancer