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Relive the July 2, 2020 lectures, live discussions, and Q&A sessions on laparoscopic right hemicolectomy, including the following topics: rationale of complete mesocolic excision (A Melani, MD, MsC), variations in right colic vascular anatomy: preoperative planning and intraoperative techniques (F Corcione, MD), and prerecorded live surgeries.

IRCAD online course – Laparoscopic right hemicolectomy - Day 1

Cours en ligne IRCAD - Hémicolectomie droite par laparoscopie - Jour 1

Cours en ligne IRCAD - Hémicolectomie droite par laparoscopie - Jour 2

Relive the July 3, 2020 lectures, live discussions, and Q&A sessions on laparoscopic right hemicolectomy, including the following topics: fluorescence intraoperative guidance (S Morales Conde, MD, PhD), safe anastomotic techniques: intracorporeal or extracorporeal (L Boni, MD, FACS), management of complications (D Mutter, MD, PhD, FACS)

IRCAD online course – Laparoscopic right hemicolectomy - Day 2

Watch the replay of the last IRCAD online private course dedicated to left colectomy (day 1) held on August 20, 2020.

IRCAD Online Course - Left colectomy (day 1)

Cours en ligne IRCAD - Colectomie gauche (jour 1)

Watch the replay of the last IRCAD online private course dedicated to left colectomy (day 2) held on August 21, 2020.

IRCAD Online Course 4 - Left colectomy (day 2)

Cours en ligne IRCAD - Colectomie gauche (jour 2)

Watch the replay of the IRCAD online course (day 1) dedicated to rectal surgery, basic principles, and key surgical steps, which was held on September 24, 2020.

IRCAD Online Course - Rectal surgery (day 1)

Cours en ligne IRCAD - Chirurgie rectale (jour 1)

Cours en ligne IRCAD - Chirurgie rectale (jour 2)

Watch the replay of the IRCAD online course (day 2) dedicated to challenges and opportunities in rectal surgery, which was held on September 25, 2020.

IRCAD Online Course - Rectal surgery (day 2)

surgical intervention video

Sigmoïdectomie laparoscopique, anastomose colorectale et drainage d'une péritonite chez un patient atteint de diverticulite de Hinchey III

This is the case of a 57-year-old woman (56kg, BMI of 26.7), with no medical condition, ASA I, and no previous surgeries. She had three previous episodes of diverticular disease. Her last in-patient treatment was performed in June 2020 because of Hinchey Ib diverticulitis who required medical treatment only. The patient was admitted to the emergency room (ER) with abdominal pain, distention, and nausea. On physical examination, dehydration, localized pain in the left lower quadrant, no signs of peritonitis, no signs of an inflammatory response were noted. Lab findings were within normal parameters. The ER medical staff decided on out-treatment. Three days later, the patient is readmitted to the ER because of persisting abdominal pain, vomit, and diarrhea. 

During admission assessment to ER, the following was observed: localized abdominal pain, no signs of peritonitis, blood cell counts with no abnormalities, WBC 4600, C reactive protein: 257mg/L (0-15mg/L), COVID-19 PCR negative, no signs of organ failure. IV contrast abdomen CT found numerous diverticula in the descending and sigmoid colon, stranding of pericolic fat, sigmoid wall enlargement, a 5cm pelvic abscess, a 3cm paracolic abscess, a 2cm central mesenteric abscess, mild free liquid at lateral gutters, compatible with a Hinchey II diverticulitis. The patient was sent to general hospitalization at the surgery ward, for antibiotic treatment with meropenem and percutaneous drainage on the following day. Twenty-four hours later, a C reactive protein double-fold is detected (575.1mg/L) and hemodynamic instability required vasoactive agents (norepinephrine). The patient was then scheduled for a diagnostic laparoscopy, which evidenced a Hinchey III diverticulitis. Surgeons performed a laparoscopic sigmoidectomy plus a primary end-to-end anastomosis, and peritoneal lavage, without any complications. Postoperative outcomes are uneventful. Oral intake starts the next day in the afternoon. The patient completes 5 days of postoperative intravenous antibiotic treatment and she is discharged on POD 6, with previous removal of Blake drains. Histopathology findings demonstrated the presence of a complicated acute diverticulitis, with severe inflammation, fat necrosis, and no neoplastic tissue. Follow-up at 30 days showed no complications or ER consultations.

Laparoscopic sigmoidectomy, colorectal anastomosis and drainage of peritonitis in a Hinchey III diverticulitis patient

Introduction: Nowadays, total mesorectal excision is considered to be the optimal rectal cancer surgery. Following this concept, in 2008, Hohenberger described complete mesocolon excision for oncologic colonic surgery. This technique is based on the separation of the parietal from the visceral fascia, resulting in the excision of the intact and complete mesocolon, and the central ligation of supplying vessels. 

Methods: The authors aim to present a stepwise laparoscopic right hemicolectomy and complete mesocolon excision. 

Results: A video showing the different steps of the procedure is presented focusing on laparoscopic right hemicolectomy and complete mesocolic excision. 

Conclusion: This standardization allows to improve and simplify the understanding of a technically challenging procedure. A step-by-step approach provides safety along with appropriate surgical outcomes. 

Laparoscopic complete mesocolic excision for right colon cancer: a standardized surgery

Excision mésocolique complète par laparoscopie pour cancer du côlon droit : une chirurgie standardisée

Colectomie droite laparoscopique et dissection du ganglion lymphatique D3 pour adénocarcinome colique et évaluation de la perfusion avec technologie au vert d'indocyanine

The aim of this video is to show anatomical landmarks and the surgical technique to perform a complete mesocolic excision (CME) in a right-sided colon cancer. The operation starts with a sharp dissection between the visceral fascia (mesocolon) and the parietal fascia (Toldt’s fascia) underneath the ileocolic trunk. The dissection moves from medially to laterally and from caudally to cranially along the route of the superior mesenteric vein until the inferior margin of the pancreas, the surgical trunk of Gillot, and the gastrocolic trunk (of Henlé) are exposed. The aim is to remove lymph node stations 203, 213, and 223. The ileocolic trunk is divided and ligated at its origin and the same maneuver is performed for the right middle colic artery (RMCA). The transverse colon and the terminal ileum are divided. The colon is mobilized and an ileo-transverse intracorporeal stapled anastomosis is created. The use of indocyanine green (ICG) is very useful to help identify some critical zones as shown in the video. The mesocolic sail was complete. There were no major vascular lesions or other complications. The operation time was 144 minutes. 

Laparoscopic right colectomy + D3 lymph node dissection for colon adenocarcinoma and perfusion assessment with ICG technology

Laparoscopic surgery for rectal cancer is a well-established approach. However, it should be performed by expert surgeons. The main limitations of laparoscopy include the loss of three‐dimensional view, the use of non-ergonomic instruments (thereby increasing the surgeon’s physiological tremor), the need for a video camera assistant and subsequent conflicts with the assistant during the dissection, and the reduced dexterity of movements. The robotic approach helps to overcome such limitations, facilitating the dissection and reducing the learning curve. Of note, the system allows the surgeon to control the high‐definition 3D camera, reducing physiological tremor and offering three extra degrees of movement using articulated instruments. This video shows an anterior rectal dissection using the da Vinci Xi™ surgical robotic system. All of the previously cited advantages of the robotic system can be appreciated. 

Focus on colorectal surgery