Laparoscopic right colectomy: bottom-to-up approach with intracorporeal anastomosis

Ureteral injuries during laparoscopic procedure are reported in about 1% of cases. In this key lecture, Professor Joël Leroy looks into the prevention, diagnosis and management of this challenging complication.

In this educational video, Professor Luc Soler gives a brief introduction of 3D reconstruction and modeling. Dr. Corcione introduces the main principles of trocar and port placement. He briefly demonstrates the technical aspects, main principles and key steps of laparoscopic sigmoidectomy for cancer in a 61-year-old male patient in a live interactive surgery. He highlights the technical aspects and main principles of lesser sac opening, vascular identification and division, splenic flexure mobilization, lateral mobilization, transection, suprapubic incision for specimen removal, and EEA anastomosis.

Single port operations are usually presented for appendectomies and cholecystectomies. We present the case of an 84-year-old man who presented recently to our department with Iron Deficiency Anemia (IDA).
A CT-colonography identified a caecal tumor, which was proven malignant by biopsies taken at a subsequent colonoscopy. Radiologically, this appeared to be an early T3 N0 tumor.
Because of his favorable body habitus and well-localized lesion, we elected to perform his laparoscopic-assisted right hemicolectomy by a single port technique.

The video demonstrates the case of a woman with recurrent diverticulitis, BMI 30. She has a background of a previous hysterectomy via a Pfannenstiel incision. A three-port sigmoidectomy with transanal excision was carried out.
Methods
The set up consisted of a 12mm umbilical optical port, a 12mm port in the right iliac fossa, and a 5mm operating port in the right flank. After initial peritoneoscopy, any abnormal adhesions were divided. The sigmoid colon mesentery was divided high, near the sigmoid colon in order to preserve the mesenteric vasculature. The mesentery was divided to the level of the rectum, which was then skeletonized. The proximal colon was mobilized free up to the level of the splenic flexure. The rectum was then ligated, washed out with betadine and transected. A Vicryl Loop was attached to the proximal stump which was then removed transanally. A colotomy was created above the level of the diverticula and the anvil of a circular stapler introduced into the proximal colon. The proximal sigmoid colon mesentery was divided and the sigmoid transected with a linear stapler. The specimen was then fully removed transanally. The anvil was then delivered through the colon via the fishing technique. The rectal stump was closed with a linear stapler. A colorectal anastomosis was fashioned with a circular stapler. After verifying that the colon was not twisted, an air test was performed.
Conclusion
The video demonstrates a three-port technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE).

High-resolution MRI is proved to have a high degree of diagnostic accuracy for T-stage of rectal carcinoma. Preoperative MRI is helpful in treatment planning. In this lecture, Dr. Brown proves the importance of MRI in the accuracy of rectal staging.

We present our technique for totally laparoscopic right colectomy for locally advanced colon cancer with transvaginal specimen extraction. The patient was a 73-year-old female who presented with a biopsy proven cecal adenocarcinoma. We performed a right hemicolectomy using a 4 port approach with the patient in modified lithotomy position. Medial to lateral mobilization and early high ligation of the ileocolic pedicle were performed. The resected specimen was placed in a large retrieval bag.
With the patient positioned in modified lithotomy, a posterior culpotomy was made and the specimen removed intact through the vagina. The culpotomy was closed from the vaginal approach. A 60mm stapled side-to-side anastomosis was created intracorporeally to complete the procedure. The specimen was 52cm in length and contained a 3.2cm tumor and 13 lymph nodes. The patient's pathologic stage was T3N1.

The objective of this film is to show the possibilities of the laparoscopic approach after percutaneous treatment of a pelvic abscess on a perforated sigmoid diverticulitis. After exploration of the abdominal cavity, the author demonstrates the interest of using new energy devices for the dissection of inflammatory tissues.