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General and digestive surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Totally laparoscopic splenic flexure resection for cancer
The objective of this video is to demonstrate a laparoscopic segmental oncological splenic flexure colonic resection for cancer. Splenic flexure carcinoma is a rare condition, as it represents 3 to 8% of all colon cancers. It is associated with a high risk of obstruction and a poor prognosis. The surgical approach is challenging and not fully standardized. The resected area must include the mesocolon with major vessels ligation at their origin, in order to reduce local recurrence via the complete removal of potentially involved lymph node stations.
The oncological effectiveness of a segmental resection could be determined by the peculiar lymphatic spread of splenic flexure cancers. Different studies showed that the majority of positive lymph nodes among patients with splenic flexure carcinoma are distributed along the paracolic arcade and the left colic artery. As a result, a segmental resection associated with a medial-to-lateral approach could be safe and effective. The experience with a totally laparoscopic approach with intracorporeal anastomosis is well described in the current literature. Additionally, an intracorporeal anastomosis minimizes the risk of bowel twisting, preventing the exteriorization of the stumps, and reducing bowel traction, which can affect anastomotic irrigation, especially in obese patients. In a setting of surgeons experienced with laparoscopic colorectal surgery, the outcomes of laparoscopic segmental resection of splenic flexure are similar to those of laparoscopic resections for cancer in other locations.
G Basili, D Pietrasanta, N Romano, AF Costa
Surgical intervention
23 days ago
942 views
4 likes
0 comments
10:12
Totally laparoscopic splenic flexure resection for cancer
The objective of this video is to demonstrate a laparoscopic segmental oncological splenic flexure colonic resection for cancer. Splenic flexure carcinoma is a rare condition, as it represents 3 to 8% of all colon cancers. It is associated with a high risk of obstruction and a poor prognosis. The surgical approach is challenging and not fully standardized. The resected area must include the mesocolon with major vessels ligation at their origin, in order to reduce local recurrence via the complete removal of potentially involved lymph node stations.
The oncological effectiveness of a segmental resection could be determined by the peculiar lymphatic spread of splenic flexure cancers. Different studies showed that the majority of positive lymph nodes among patients with splenic flexure carcinoma are distributed along the paracolic arcade and the left colic artery. As a result, a segmental resection associated with a medial-to-lateral approach could be safe and effective. The experience with a totally laparoscopic approach with intracorporeal anastomosis is well described in the current literature. Additionally, an intracorporeal anastomosis minimizes the risk of bowel twisting, preventing the exteriorization of the stumps, and reducing bowel traction, which can affect anastomotic irrigation, especially in obese patients. In a setting of surgeons experienced with laparoscopic colorectal surgery, the outcomes of laparoscopic segmental resection of splenic flexure are similar to those of laparoscopic resections for cancer in other locations.
Laparoscopic right colectomy: bottom-to-up approach with intracorporeal anastomosis
Introduction
Laparoscopic right colectomy (LRC) has become a well-established technique in colon cancer treatment achieving the same degree of radicality as open colectomy with the advantages of minimal invasion. A medial-to-lateral approach is the standard technique, but the bottom-to-up approach, with intracorporeal anastomosis (BTU), has recently gained popularity among surgeons.
Clinical case
The authors report the case of a 70-year-old male patient with persistent abdominal discomfort and a change in bowel habits. Preoperative staging revealed an adenocarcinoma at the hepatic flexure of the colon with no metastatic disease. The patient was proposed for a laparoscopic right colectomy.
A bottom-to-up approach was performed by opening an avascular plane posterior to the right mesocolon, creating a mesenteric route cranially along Gerota’s fascia until the duodenum and liver have been exposed. A side-to-side ileocolic intracorporeal stapled anastomosis was fashioned. The procedure and postoperative recovery were uneventful.
Discussion/Conclusion
LRC using a BTU approach is a feasible and safe alternative to the conventional medial-to-lateral approach. The main advantages are a short learning curve and an easy access to the retroperitoneal space with direct visualization and protection of retroperitoneal structures. The performance of an intracorporeal anastomosis offers the advantage of a smaller extraction incision, lower wound-related complications, and fast recovery.
J Magalhães, L Matos, J Costa, J Costa Pereira, G Gonçalves, M Nora
Surgical intervention
27 days ago
678 views
6 likes
3 comments
10:31
Laparoscopic right colectomy: bottom-to-up approach with intracorporeal anastomosis
Introduction
Laparoscopic right colectomy (LRC) has become a well-established technique in colon cancer treatment achieving the same degree of radicality as open colectomy with the advantages of minimal invasion. A medial-to-lateral approach is the standard technique, but the bottom-to-up approach, with intracorporeal anastomosis (BTU), has recently gained popularity among surgeons.
Clinical case
The authors report the case of a 70-year-old male patient with persistent abdominal discomfort and a change in bowel habits. Preoperative staging revealed an adenocarcinoma at the hepatic flexure of the colon with no metastatic disease. The patient was proposed for a laparoscopic right colectomy.
A bottom-to-up approach was performed by opening an avascular plane posterior to the right mesocolon, creating a mesenteric route cranially along Gerota’s fascia until the duodenum and liver have been exposed. A side-to-side ileocolic intracorporeal stapled anastomosis was fashioned. The procedure and postoperative recovery were uneventful.
Discussion/Conclusion
LRC using a BTU approach is a feasible and safe alternative to the conventional medial-to-lateral approach. The main advantages are a short learning curve and an easy access to the retroperitoneal space with direct visualization and protection of retroperitoneal structures. The performance of an intracorporeal anastomosis offers the advantage of a smaller extraction incision, lower wound-related complications, and fast recovery.
Laparoscopic complete mesocolic excision (CME) right hemicolectomy with intracorporeal anastomosis
Complete mesocolic excision (CME) in colon cancer surgery has recently gained popularity as increasing evidence points to improved oncological clearance with superior lymph node yield, bigger tumor clearance margins, and higher quality surgical specimens. There are also some indications that it may lead to improved oncological outcomes. The tenets of CME include high vascular ligation at the root of the vessel, dissection along the embryological planes of the colonic mesentery, and adequate margins of bowel from the tumor.
Although the technique was initially described and achieved via a laparotomy, laparoscopic CME was also performed, although it was noted to be technically challenging. The right colon and the variability of vascular anatomy add to the difficulty of the procedure.
Extracorporeal anastomosis is commonly performed for right hemicolectomy in most centers. There are some reported advantages to the intracorporeal anastomosis, namely a potentially higher lymph node yield, a smaller skin incision, and the ability to extract the specimen via a Pfannenstiel’s incision, which has lower rates of incisional hernia.
This video features a laparoscopic CME right hemicolectomy with intracorporeal anastomosis for a malignant polyp.
SAE Yeo
Surgical intervention
9 months ago
8552 views
1071 likes
0 comments
13:33
Laparoscopic complete mesocolic excision (CME) right hemicolectomy with intracorporeal anastomosis
Complete mesocolic excision (CME) in colon cancer surgery has recently gained popularity as increasing evidence points to improved oncological clearance with superior lymph node yield, bigger tumor clearance margins, and higher quality surgical specimens. There are also some indications that it may lead to improved oncological outcomes. The tenets of CME include high vascular ligation at the root of the vessel, dissection along the embryological planes of the colonic mesentery, and adequate margins of bowel from the tumor.
Although the technique was initially described and achieved via a laparotomy, laparoscopic CME was also performed, although it was noted to be technically challenging. The right colon and the variability of vascular anatomy add to the difficulty of the procedure.
Extracorporeal anastomosis is commonly performed for right hemicolectomy in most centers. There are some reported advantages to the intracorporeal anastomosis, namely a potentially higher lymph node yield, a smaller skin incision, and the ability to extract the specimen via a Pfannenstiel’s incision, which has lower rates of incisional hernia.
This video features a laparoscopic CME right hemicolectomy with intracorporeal anastomosis for a malignant polyp.
Laparoscopic right hemicolectomy with complete mesocolic excision for advanced ascending colon cancer
Complete mesocolic excision (CME) with central vascular ligation (CVL) is a potentially superior oncological technique in colon cancer surgery. The tenets of high vascular ligation at the origin and mesocolic dissection facilitate a greater lymph node yield. We present the case of a 70-year-old lady with chronic right iliac fossa discomfort. Computer tomographic scans showed a bulky ascending colon cancer with a 2.6cm right mesocolic lymph node. She underwent laparoscopic CME right hemicolectomy with CVL. Three operative trocars were used (a 12mm trocar in the left iliac fossa, 5mm ports in the left flank and right iliac fossa). Dissection begins in an inferior to superior approach, starting with mobilization of the ileocolic mesentery off the right common iliac vessels, then progressing to separate the mesentery off the duodenum and Gerota's fascia, exposing the head of the pancreas and the duodenal loop. CVL begins with the identification of the superior mesenteric vein (SMV). The vascular structures are isolated individually and ligated high at the level of the SMV, removing the metastatic right mesocolic node ‘en bloc’. Following proximal and distal transections, an intracorporeal ileo-transverse anastomosis is performed. Histology findings demonstrate the presence of a pT4a N2a M0 mucinous adenocarcinoma with 5 out of 17 lymph nodes (including the large mesocolic lymph node) positive for metastasis.
JL Ng, SAE Yeo
Surgical intervention
1 year ago
11278 views
1169 likes
0 comments
05:37
Laparoscopic right hemicolectomy with complete mesocolic excision for advanced ascending colon cancer
Complete mesocolic excision (CME) with central vascular ligation (CVL) is a potentially superior oncological technique in colon cancer surgery. The tenets of high vascular ligation at the origin and mesocolic dissection facilitate a greater lymph node yield. We present the case of a 70-year-old lady with chronic right iliac fossa discomfort. Computer tomographic scans showed a bulky ascending colon cancer with a 2.6cm right mesocolic lymph node. She underwent laparoscopic CME right hemicolectomy with CVL. Three operative trocars were used (a 12mm trocar in the left iliac fossa, 5mm ports in the left flank and right iliac fossa). Dissection begins in an inferior to superior approach, starting with mobilization of the ileocolic mesentery off the right common iliac vessels, then progressing to separate the mesentery off the duodenum and Gerota's fascia, exposing the head of the pancreas and the duodenal loop. CVL begins with the identification of the superior mesenteric vein (SMV). The vascular structures are isolated individually and ligated high at the level of the SMV, removing the metastatic right mesocolic node ‘en bloc’. Following proximal and distal transections, an intracorporeal ileo-transverse anastomosis is performed. Histology findings demonstrate the presence of a pT4a N2a M0 mucinous adenocarcinoma with 5 out of 17 lymph nodes (including the large mesocolic lymph node) positive for metastasis.
LIVE INTERACTIVE SURGERY: Interactive discussion around splenic flexure during laparoscopic sigmoidectomy for cancer
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.
F Corcione, D Mutter, J Marescaux
Surgical intervention
1 year ago
5995 views
320 likes
0 comments
58:02
LIVE INTERACTIVE SURGERY: Interactive discussion around splenic flexure during laparoscopic sigmoidectomy for cancer
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.
Laparoscopic left complete mesocolic excision for stented descending colon cancer
Complete mesocolic excision (CME) with central vessel ligation (CVL) was first introduced with the aim to preserve an intact layer of mesocolon, containing all blood vessels, lymphatic vessels, lymph nodes, and surrounding soft tissue during colorectal cancer resection. The supplying vessels are also transected at their origin for optimal oncological outcomes. This method has been extensively studied in right colonic cancers with improvement in local recurrence and survival rates when compared to the conventional approach. Its excellent results are attributed to the superior lymph node harvest and removal of disseminated cancer cells in the surrounding soft tissue. Similarly, such advantages can be translated to left hemicolectomy with the use of CME with a CVL approach. Additionally, in left hemicolectomy, the vessels ligated (left branch of middle colic and left colic) are branches of vessels from the aorta rather than from the aorta directly, often limiting lymph node harvest. CME with CVL can help to overcome this limitation in left hemicolectomy. We present a video of a laparoscopic CME and CVL in a 48-year-old Chinese male with large bowel obstruction secondary to a descending colonic tumor which was successfully stented one week before.
SAE Yeo, MH Chang
Surgical intervention
1 year ago
2886 views
315 likes
0 comments
08:47
Laparoscopic left complete mesocolic excision for stented descending colon cancer
Complete mesocolic excision (CME) with central vessel ligation (CVL) was first introduced with the aim to preserve an intact layer of mesocolon, containing all blood vessels, lymphatic vessels, lymph nodes, and surrounding soft tissue during colorectal cancer resection. The supplying vessels are also transected at their origin for optimal oncological outcomes. This method has been extensively studied in right colonic cancers with improvement in local recurrence and survival rates when compared to the conventional approach. Its excellent results are attributed to the superior lymph node harvest and removal of disseminated cancer cells in the surrounding soft tissue. Similarly, such advantages can be translated to left hemicolectomy with the use of CME with a CVL approach. Additionally, in left hemicolectomy, the vessels ligated (left branch of middle colic and left colic) are branches of vessels from the aorta rather than from the aorta directly, often limiting lymph node harvest. CME with CVL can help to overcome this limitation in left hemicolectomy. We present a video of a laparoscopic CME and CVL in a 48-year-old Chinese male with large bowel obstruction secondary to a descending colonic tumor which was successfully stented one week before.
Laparoscopic anterior resection for locally advanced sigmoid cancer with 'en bloc' excision of bladder cuff
We present an operative video of a 61-year-old Chinese gentleman with locally advanced sigmoid carcinoma. Preoperative histology from endoscopy revealed an adenocarcinoma. The patient underwent laparoscopic anterior resection. Intraoperatively, the sigmoid tumor was adherent to the bladder with surrounding inflammation and edema. The colectomy had to be performed with an ‘en bloc’ excision of a bladder cuff. The bladder defect was repaired laparoscopically in two layers. Operative time was 4 hours 15 minutes and total blood loss was less than 100mL. The patient was discharged in good health conditions, four days after the operation with an outpatient cystogram performed before subsequent successful removal of the indwelling catheter. Final histology was pT4bN0 (0/31 lymph nodes) with clear margins. This case demonstrates that laparoscopic colectomy with ‘en bloc’ bladder cuff excision and subsequent laparoscopic repair of bladder defect are both feasible and safe.
S Mantoo, E Yong
Surgical intervention
2 years ago
3127 views
139 likes
0 comments
07:26
Laparoscopic anterior resection for locally advanced sigmoid cancer with 'en bloc' excision of bladder cuff
We present an operative video of a 61-year-old Chinese gentleman with locally advanced sigmoid carcinoma. Preoperative histology from endoscopy revealed an adenocarcinoma. The patient underwent laparoscopic anterior resection. Intraoperatively, the sigmoid tumor was adherent to the bladder with surrounding inflammation and edema. The colectomy had to be performed with an ‘en bloc’ excision of a bladder cuff. The bladder defect was repaired laparoscopically in two layers. Operative time was 4 hours 15 minutes and total blood loss was less than 100mL. The patient was discharged in good health conditions, four days after the operation with an outpatient cystogram performed before subsequent successful removal of the indwelling catheter. Final histology was pT4bN0 (0/31 lymph nodes) with clear margins. This case demonstrates that laparoscopic colectomy with ‘en bloc’ bladder cuff excision and subsequent laparoscopic repair of bladder defect are both feasible and safe.
Laparoscopic right hemicolectomy (mesocolic excision) in advanced right colonic tumor with parietal fixation (T4)
Similar to TME in rectal cancer, a comparable approach for the surgical resection of colonic cancers is described as complete mesocolic excision (CME), which includes central vascular ligation and dissection in the mesocolic space. According to a recently published Danish study, a 4-year disease-free survival (DFS) in the CME group was 85.8% whereas it was 75.9 % in the conventional group. Here, we present a video demonstration of laparoscopic right radical hemicolectomy in which complete mesocolic excision was performed. The mesocolic layer was identified as a shiny avascular film, which was preserved during the procedure in order to limit tumor dissemination. In this medial to lateral approach, the first duodenum is identified by incising the peritoneum and using a gauze piece for dissection purposes in an avascular plane, making sure to preserve the mesocolon. The right colic vessel is identified and clipped. The right branch of the middle colic artery and the ileocolic vessel are ligated. All fibrotic and adipose tissues are swept along with the specimen, and the ureter and gonadal vessels are dissected away. Lateral mobilization is achieved, and the specimen is then removed through small transverse incision to prepare for an extracorporeal ileo-transverse anastomosis.
S Puntambekar, V Sharma, H Parikh, G Joshi, S Mitkare, A Dokrimare
Surgical intervention
3 years ago
14974 views
593 likes
2 comments
11:00
Laparoscopic right hemicolectomy (mesocolic excision) in advanced right colonic tumor with parietal fixation (T4)
Similar to TME in rectal cancer, a comparable approach for the surgical resection of colonic cancers is described as complete mesocolic excision (CME), which includes central vascular ligation and dissection in the mesocolic space. According to a recently published Danish study, a 4-year disease-free survival (DFS) in the CME group was 85.8% whereas it was 75.9 % in the conventional group. Here, we present a video demonstration of laparoscopic right radical hemicolectomy in which complete mesocolic excision was performed. The mesocolic layer was identified as a shiny avascular film, which was preserved during the procedure in order to limit tumor dissemination. In this medial to lateral approach, the first duodenum is identified by incising the peritoneum and using a gauze piece for dissection purposes in an avascular plane, making sure to preserve the mesocolon. The right colic vessel is identified and clipped. The right branch of the middle colic artery and the ileocolic vessel are ligated. All fibrotic and adipose tissues are swept along with the specimen, and the ureter and gonadal vessels are dissected away. Lateral mobilization is achieved, and the specimen is then removed through small transverse incision to prepare for an extracorporeal ileo-transverse anastomosis.
Manual colorectal anastomosis during suprapubic single incision laparoscopic left hemicolectomy
Background: Single incision laparoscopic left hemicolectomy is a feasible procedure. A suprapubic access allows to offer satisfactory cosmetic results in case of an extended scar due to a large tumor. An intracorporeal circular mechanical anastomosis is the most common type. A manual anastomosis is feasible and allows to control lumen opening, potential bleeding, and overall to overcome the difficulty of transanal stapler insertion in case of high rectal transection.
Video: This video shows two different types of manual colorectal anastomosis, through a right suprapubic access.
1) Double-layer end-to-end
2) Monolayer end-to-end
Results: After an appropriate learning curve, time to perform the manual anastomosis is 40 minutes.
Conclusions: Different colorectal anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire left hemicolectomy, please click here.
G Dapri
Surgical intervention
3 years ago
3728 views
85 likes
0 comments
04:02
Manual colorectal anastomosis during suprapubic single incision laparoscopic left hemicolectomy
Background: Single incision laparoscopic left hemicolectomy is a feasible procedure. A suprapubic access allows to offer satisfactory cosmetic results in case of an extended scar due to a large tumor. An intracorporeal circular mechanical anastomosis is the most common type. A manual anastomosis is feasible and allows to control lumen opening, potential bleeding, and overall to overcome the difficulty of transanal stapler insertion in case of high rectal transection.
Video: This video shows two different types of manual colorectal anastomosis, through a right suprapubic access.
1) Double-layer end-to-end
2) Monolayer end-to-end
Results: After an appropriate learning curve, time to perform the manual anastomosis is 40 minutes.
Conclusions: Different colorectal anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire left hemicolectomy, please click here.
Four different intracorporeal ileocolic anastomoses during suprapubic single incision laparoscopic right hemicolectomy
Background: Single incision laparoscopic right hemicolectomy is a feasible procedure. Suprapubic access allows to offer satisfactory cosmetic results in case of extended scar due to a large tumor. Intracorporeal anastomosis is mandatory through a suprapubic access, because it prevents traction on the mesentery and on the transverse mesocolon.
Video: This video shows four different types of intracorporeal ileocolic anastomoses.
1) Linear mechanical side-to-side
2) Completely manual side-to-side
3) Completely manual end-to-side
4) Completely manual end-to-end
At the end of each type of anastomosis, mesenteric defect closure is mandatory, to prevent intestinal obstruction caused by internal hernia.
Results: After an appropriate learning curve, time to perform linear mechanical anastomosis is 25 minutes and manual anastomosis takes 40 minutes.
Conclusions: Different ileocolic anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire right hemicolectomy, please click here.
G Dapri
Surgical intervention
3 years ago
3626 views
177 likes
0 comments
07:58
Four different intracorporeal ileocolic anastomoses during suprapubic single incision laparoscopic right hemicolectomy
Background: Single incision laparoscopic right hemicolectomy is a feasible procedure. Suprapubic access allows to offer satisfactory cosmetic results in case of extended scar due to a large tumor. Intracorporeal anastomosis is mandatory through a suprapubic access, because it prevents traction on the mesentery and on the transverse mesocolon.
Video: This video shows four different types of intracorporeal ileocolic anastomoses.
1) Linear mechanical side-to-side
2) Completely manual side-to-side
3) Completely manual end-to-side
4) Completely manual end-to-end
At the end of each type of anastomosis, mesenteric defect closure is mandatory, to prevent intestinal obstruction caused by internal hernia.
Results: After an appropriate learning curve, time to perform linear mechanical anastomosis is 25 minutes and manual anastomosis takes 40 minutes.
Conclusions: Different ileocolic anastomoses can be performed and the surgeon has to choose the appropriate one, case by case.
To watch the video demonstrating the entire right hemicolectomy, please click here.
Suprapubic single incision laparoscopic left hemicolectomy (SILLH): an alternative to the umbilical access
Background: Single incision laparoscopy (SIL) has been described for colorectal surgery because it mainly provides an improved cosmetic outcome. A suprapubic access can be considered an alternative to the umbilical site for left hemicolectomy (LH) because the scar remains under the bikini line and can be considered cosmetically acceptable.

Video: A 61-year-old man was admitted to hospital for adenocarcinoma of the sigmoid colon; preoperative work-up did not show the presence of secondary lesions. A suprapubic SILLH was proposed to the patient. The technique consisted in performing the procedure through an initial 3.5cm skin incision, localized suprapubically, with the insertion of 3 reusable trocars vertically in a pararectal axis along with DAPRI curved reusable instruments (Karl Storz Endoskope, Tüttlingen, Germany). The vascular plane was firstly controlled by clips and, after mobilization of the entire left colon, the upper rectum was transected and the specimen was removed using the same access; a conventional circular transanal anastomosis was performed.

Results: Laparoscopic time was 119 minutes, estimated blood loss was 20cc, and the final scar length measured 4.5cm. Pathology confirmed the presence of a colon adenocarcinoma (pT2N0Mx). Postoperative pain was minimal, allowing the patient to be discharged on postoperative day 4.

Conclusions: Suprapubic SILLH offers the option to enlarge the skin incision according to the specimen’s size without any cosmetic damage, because it remains under the bikini line. The dissection plane appears in front of the access and postoperative pain remains minimal.
G Dapri
Surgical intervention
5 years ago
4179 views
29 likes
1 comment
08:07
Suprapubic single incision laparoscopic left hemicolectomy (SILLH): an alternative to the umbilical access
Background: Single incision laparoscopy (SIL) has been described for colorectal surgery because it mainly provides an improved cosmetic outcome. A suprapubic access can be considered an alternative to the umbilical site for left hemicolectomy (LH) because the scar remains under the bikini line and can be considered cosmetically acceptable.

Video: A 61-year-old man was admitted to hospital for adenocarcinoma of the sigmoid colon; preoperative work-up did not show the presence of secondary lesions. A suprapubic SILLH was proposed to the patient. The technique consisted in performing the procedure through an initial 3.5cm skin incision, localized suprapubically, with the insertion of 3 reusable trocars vertically in a pararectal axis along with DAPRI curved reusable instruments (Karl Storz Endoskope, Tüttlingen, Germany). The vascular plane was firstly controlled by clips and, after mobilization of the entire left colon, the upper rectum was transected and the specimen was removed using the same access; a conventional circular transanal anastomosis was performed.

Results: Laparoscopic time was 119 minutes, estimated blood loss was 20cc, and the final scar length measured 4.5cm. Pathology confirmed the presence of a colon adenocarcinoma (pT2N0Mx). Postoperative pain was minimal, allowing the patient to be discharged on postoperative day 4.

Conclusions: Suprapubic SILLH offers the option to enlarge the skin incision according to the specimen’s size without any cosmetic damage, because it remains under the bikini line. The dissection plane appears in front of the access and postoperative pain remains minimal.
Laparoscopic total colectomy for T4N0M0 right colonic cancer and Lynch syndrome
The authors demonstrate their technique of laparoscopic total colectomy indicated for T3 tumors of the right transverse colon in a 40-year-old man with a family history of Lynch syndrome. Colonoscopy performed 3 years earlier ruled out the presence of polyps. Due to the tumor's invasiveness and the necessity to perform repeated endoscopic monitoring, it was decided to perform a total colectomy. The intervention is begun to the right and is completed to the left making sure to avoid any tumor manipulation. The different steps of the procedure are clearly outlined with images of outstanding quality. The vascular approach, especially to the right along the superior mesenteric axis, is beautifully exposed.
J Leroy, J Marescaux
Surgical intervention
5 years ago
5648 views
112 likes
0 comments
28:29
Laparoscopic total colectomy for T4N0M0 right colonic cancer and Lynch syndrome
The authors demonstrate their technique of laparoscopic total colectomy indicated for T3 tumors of the right transverse colon in a 40-year-old man with a family history of Lynch syndrome. Colonoscopy performed 3 years earlier ruled out the presence of polyps. Due to the tumor's invasiveness and the necessity to perform repeated endoscopic monitoring, it was decided to perform a total colectomy. The intervention is begun to the right and is completed to the left making sure to avoid any tumor manipulation. The different steps of the procedure are clearly outlined with images of outstanding quality. The vascular approach, especially to the right along the superior mesenteric axis, is beautifully exposed.
Suprapubic single incision laparoscopic right hemicolectomy with intracorporeal anastomosis
Background: Single incision laparoscopy (SIL) has recently sparked considerable interest. The objectives of this technique are to improve cosmetic outcomes and to reduce invasiveness. Until now the umbilicus was the preferred way of entry, but suprapubic access can be an alternative especially for right hemicolectomy.

Clinical case: A 50-year-old male, without previous surgical history and a body mass index of 22 kg/m2 underwent colonoscopy due to anemia. A large base polyp was found in the right colon, and biopsy revealed a colic adenocarcinoma. No distant metastasis or lymphadenopathies were found during preoperative work-up. The technique consisted in performing the resection through the suprapubic access, using three reusable ports and reusable curved instruments according to Dapri (Karl Storz Endoskope). An intracorporeal anastomosis using a linear stapler was performed, the mesenteric defect was closed, and the access site was finally used for specimen extraction.

Results: No additional trocars or conversion to open surgery were necessary. Laparoscopic time was 240 minutes and the final incision length was 4.5cm. Pathological data confirmed the presence of a pT1N0 colonic adenocarcinoma, with 22 negative nodes. The postoperative course was uneventful and the patient was discharged on postoperative day 4.

Conclusions: Suprapubic SIL is a useful technique for right hemicolectomy because the mesocolic and the mesenteric dissections are performed on the same axis as the access site. Intracorporeal anastomosis is carried out without traction, and the gravitational effect of the operating table allows to expose the operative field and to maneuver the colon and the small bowel intracorporeally. Finally, this access can be enlarged for the extraction of the specimen without cosmetic damage.
G Dapri
Surgical intervention
6 years ago
4525 views
44 likes
1 comment
07:18
Suprapubic single incision laparoscopic right hemicolectomy with intracorporeal anastomosis
Background: Single incision laparoscopy (SIL) has recently sparked considerable interest. The objectives of this technique are to improve cosmetic outcomes and to reduce invasiveness. Until now the umbilicus was the preferred way of entry, but suprapubic access can be an alternative especially for right hemicolectomy.

Clinical case: A 50-year-old male, without previous surgical history and a body mass index of 22 kg/m2 underwent colonoscopy due to anemia. A large base polyp was found in the right colon, and biopsy revealed a colic adenocarcinoma. No distant metastasis or lymphadenopathies were found during preoperative work-up. The technique consisted in performing the resection through the suprapubic access, using three reusable ports and reusable curved instruments according to Dapri (Karl Storz Endoskope). An intracorporeal anastomosis using a linear stapler was performed, the mesenteric defect was closed, and the access site was finally used for specimen extraction.

Results: No additional trocars or conversion to open surgery were necessary. Laparoscopic time was 240 minutes and the final incision length was 4.5cm. Pathological data confirmed the presence of a pT1N0 colonic adenocarcinoma, with 22 negative nodes. The postoperative course was uneventful and the patient was discharged on postoperative day 4.

Conclusions: Suprapubic SIL is a useful technique for right hemicolectomy because the mesocolic and the mesenteric dissections are performed on the same axis as the access site. Intracorporeal anastomosis is carried out without traction, and the gravitational effect of the operating table allows to expose the operative field and to maneuver the colon and the small bowel intracorporeally. Finally, this access can be enlarged for the extraction of the specimen without cosmetic damage.
Laparoscopic right colectomy for caecal cancer using Sonicision™ cordless ultrasonic dissection device
The interest of this video is to demonstrate a fully laparoscopic oncologic right colectomy technique performed by means of novel dissection instruments such as the Sonicision™ cordless ultrasonic dissection device (Valleylab, Covidien) as well as stapling devices designed for anastomosis (Endo-GIA™ Tri-staple™ technology, Covidien). Regarding the Sonicision™ cordless ultrasonic dissection device, one may appreciate its efficacy, notably to achieve hemostasis of ileocolic and right colic vessels.
Its simplicity of use and safety in controlling the action to coagulate and divide tissues have been strongly appreciated from the operator’s side who is a regular user of the Ligasure™ technology. The great freedom of movement related to the absence of cable and to the lightness of the instrument accounts mostly for the almost immediate adoption of this novel laparoscopic instrument.
J Leroy, J Marescaux
Surgical intervention
6 years ago
5686 views
133 likes
0 comments
12:28
Laparoscopic right colectomy for caecal cancer using Sonicision™ cordless ultrasonic dissection device
The interest of this video is to demonstrate a fully laparoscopic oncologic right colectomy technique performed by means of novel dissection instruments such as the Sonicision™ cordless ultrasonic dissection device (Valleylab, Covidien) as well as stapling devices designed for anastomosis (Endo-GIA™ Tri-staple™ technology, Covidien). Regarding the Sonicision™ cordless ultrasonic dissection device, one may appreciate its efficacy, notably to achieve hemostasis of ileocolic and right colic vessels.
Its simplicity of use and safety in controlling the action to coagulate and divide tissues have been strongly appreciated from the operator’s side who is a regular user of the Ligasure™ technology. The great freedom of movement related to the absence of cable and to the lightness of the instrument accounts mostly for the almost immediate adoption of this novel laparoscopic instrument.
A laparoscopic right hemicolectomy with a primary vascular approach
Introduction:
We present the case of a 54-year-old male with a 5cm villous adenoma at the ileocaecal valve with a focus of invasive carcinoma. Previous attempts at endoscopic mucosal resection were unsuccessful.

Methods:
The set-up consisted of two 10/12mm ports (sub-umbilical and left iliac fossa) and three 5mm ports (right iliac fossa, supra-umbilical and epigastric). The primary vascular approach initially consists of identification, ligation and division of the vessels (ileocolic, right colic and right branch of the middle colic) at their origin, retroperitoneal mobilization of the mesocolon, taking down of the hepatic flexure and completion of the mobilization of the caecum and lateral attachments.

Conclusion:
The primary vascular approach to laparoscopic right hemi-colectomy is achievable.
M Walz, J Marescaux
Surgical intervention
6 years ago
10668 views
256 likes
0 comments
35:19
A laparoscopic right hemicolectomy with a primary vascular approach
Introduction:
We present the case of a 54-year-old male with a 5cm villous adenoma at the ileocaecal valve with a focus of invasive carcinoma. Previous attempts at endoscopic mucosal resection were unsuccessful.

Methods:
The set-up consisted of two 10/12mm ports (sub-umbilical and left iliac fossa) and three 5mm ports (right iliac fossa, supra-umbilical and epigastric). The primary vascular approach initially consists of identification, ligation and division of the vessels (ileocolic, right colic and right branch of the middle colic) at their origin, retroperitoneal mobilization of the mesocolon, taking down of the hepatic flexure and completion of the mobilization of the caecum and lateral attachments.

Conclusion:
The primary vascular approach to laparoscopic right hemi-colectomy is achievable.
Laparoscopic sigmoidectomy for T3N2M1 sigmoid cancer
Introduction:
This is the case of a 65-year-old gentleman who presented with blood per rectum (PR) and symptoms of subacute obstruction. He was diagnosed with a stenotic invasive adenocarcinoma at 15cm from the anal verge and with liver metastases. After discussion at our multidisclipinary meeting, he was recommended to undergo palliative chemotherapy in the form of FOLFIRI and Avastin. Unfortunately, his symptoms of subacute obstruction worsened and it was recommended that he undergo a palliative resection.

Methods:
He underwent a palliative Laparoscopic Anterior Resection (LAR). Professor Armondo Melani utilized a 4-port technique with a 10mm umbilical optical port and 3 by 5mm working ports (2 on the right-hand side and one on the left). He used a medial to lateral approach starting with the splenic flexure takedown. This was achieved by entering the retroperitoneal plane cephalad to the inferior mesenteric artery (IMA) and inferior to the inferior mesenteric vein (IMV). Once the correct plane has been entered, the IMV was skeletonized and divided with a Ligasure® vessel-sealing device. The lesser sac was then entered superior and cephalad to the IMV, superior to the pancreas and to the left of the middle colic vessels. This novel approach allowed for easy identification of the pancreas and retroperitoneal mobilization of the mesocolon from the pancreas. The lesser sac was then entered above the transverse colon, the omental attachments divided and splenic flexure mobilization completed. The retroperitoneal plane was then entered caudally to the IMA, which was subsequently skeletonized and divided after identification of the left ureter and gonadal vessels. The rectum was then mobilized to >5cm below the tumor, the mesorectum divided, the rectum transected with an articulating linear stapling device. The specimen was delivered through a Pfannenstiel incision (with a wound protector). The specimen was transected and the anvil of a circular stapler inserted into the proximal colon with a purse-string suture. The colon was returned to the abdomen and the colorectal anastomosis was completed with the insertion of the circular stapler transanally.
A Melani, J Marescaux
Surgical intervention
6 years ago
8364 views
129 likes
0 comments
28:38
Laparoscopic sigmoidectomy for T3N2M1 sigmoid cancer
Introduction:
This is the case of a 65-year-old gentleman who presented with blood per rectum (PR) and symptoms of subacute obstruction. He was diagnosed with a stenotic invasive adenocarcinoma at 15cm from the anal verge and with liver metastases. After discussion at our multidisclipinary meeting, he was recommended to undergo palliative chemotherapy in the form of FOLFIRI and Avastin. Unfortunately, his symptoms of subacute obstruction worsened and it was recommended that he undergo a palliative resection.

Methods:
He underwent a palliative Laparoscopic Anterior Resection (LAR). Professor Armondo Melani utilized a 4-port technique with a 10mm umbilical optical port and 3 by 5mm working ports (2 on the right-hand side and one on the left). He used a medial to lateral approach starting with the splenic flexure takedown. This was achieved by entering the retroperitoneal plane cephalad to the inferior mesenteric artery (IMA) and inferior to the inferior mesenteric vein (IMV). Once the correct plane has been entered, the IMV was skeletonized and divided with a Ligasure® vessel-sealing device. The lesser sac was then entered superior and cephalad to the IMV, superior to the pancreas and to the left of the middle colic vessels. This novel approach allowed for easy identification of the pancreas and retroperitoneal mobilization of the mesocolon from the pancreas. The lesser sac was then entered above the transverse colon, the omental attachments divided and splenic flexure mobilization completed. The retroperitoneal plane was then entered caudally to the IMA, which was subsequently skeletonized and divided after identification of the left ureter and gonadal vessels. The rectum was then mobilized to >5cm below the tumor, the mesorectum divided, the rectum transected with an articulating linear stapling device. The specimen was delivered through a Pfannenstiel incision (with a wound protector). The specimen was transected and the anvil of a circular stapler inserted into the proximal colon with a purse-string suture. The colon was returned to the abdomen and the colorectal anastomosis was completed with the insertion of the circular stapler transanally.
En bloc laparoscopic right hemicolectomy associated to atypical hepatectomy for advanced cancer of the hepatic flexure
Background: An adenocarcinoma of the hepatic colic flexure associated to liver invasion was diagnosed in a 55 year-old woman, who consulted for weight loss and anemia. The patient was submitted to neoadjuvant chemotherapy and, after 4 cycles, an en bloc laparoscopic right hemicolectomy and atypical hepatectomy of segment VI was proposed.
Video: The surgeon stood between the patient’s legs, and the cameraman to the patient’s left. Four trocars were placed in the abdomen. The right mesocolon was opened at the root of the ileocaecal vessels, which were meticulously dissected and clipped. The arterial and venous branch of the middle colic vessels were sectioned as well. The right mesocolon was freed from the duodenum respecting Toldt’s fascia. The proximal transverse colon and the distal ileum were divided by firing of a linear stapler (purple and white loads). Peroperative ultrasonography permitted exclusion of other hepatic lesions and the delimitation of the en bloc resection of segment VI. The hepatic parenchyma was transected using the coagulating hook. A laparoscopic manual side-to-side ileocolic anastomosis by 2 runnings sutures was performed. The mesocolic defect was closed, and the specimen was retrieved through a protected suprapubic incision.
Results: Operative time was 180 minutes and estimated blood loss 150 mL. The patient was discharged on the 5th postoperative day. Pathology evidenced a pT4N1 colic adenocarcinoma. She underwent additional adjuvant chemotherapy, and was doing well at the time of the last office visit.
Conclusion: Advanced colic cancer associated to hepatic invasion can be safely treated by laparoscopy.
G Dapri, J Himpens, GB Cadière
Surgical intervention
7 years ago
7019 views
41 likes
18 comments
10:17
En bloc laparoscopic right hemicolectomy associated to atypical hepatectomy for advanced cancer of the hepatic flexure
Background: An adenocarcinoma of the hepatic colic flexure associated to liver invasion was diagnosed in a 55 year-old woman, who consulted for weight loss and anemia. The patient was submitted to neoadjuvant chemotherapy and, after 4 cycles, an en bloc laparoscopic right hemicolectomy and atypical hepatectomy of segment VI was proposed.
Video: The surgeon stood between the patient’s legs, and the cameraman to the patient’s left. Four trocars were placed in the abdomen. The right mesocolon was opened at the root of the ileocaecal vessels, which were meticulously dissected and clipped. The arterial and venous branch of the middle colic vessels were sectioned as well. The right mesocolon was freed from the duodenum respecting Toldt’s fascia. The proximal transverse colon and the distal ileum were divided by firing of a linear stapler (purple and white loads). Peroperative ultrasonography permitted exclusion of other hepatic lesions and the delimitation of the en bloc resection of segment VI. The hepatic parenchyma was transected using the coagulating hook. A laparoscopic manual side-to-side ileocolic anastomosis by 2 runnings sutures was performed. The mesocolic defect was closed, and the specimen was retrieved through a protected suprapubic incision.
Results: Operative time was 180 minutes and estimated blood loss 150 mL. The patient was discharged on the 5th postoperative day. Pathology evidenced a pT4N1 colic adenocarcinoma. She underwent additional adjuvant chemotherapy, and was doing well at the time of the last office visit.
Conclusion: Advanced colic cancer associated to hepatic invasion can be safely treated by laparoscopy.
Laparoscopic left colectomy with transmesenteric colorectal anastomosis on the mid-transverse colon
The objective of this film is to show the totalization of a left partial colectomy performed one year ago and the possibility of doing a transmesenteric laparoscopic colorectal anastomosis. This patient had undergone a sigmoidectomy for sigmoid diverticulitis with a colorectal anastomosis one year ago. During the postoperative period, the patient had several subocclusive episodes and suffered from pain related to an ischemic stenosis of the lowered colon with no necrosis. The stenosis has become increasingly incapacitating, not only at the level of the anastomosis but especially at the level of the left colon, which has been getting narrower.
J Leroy, J Marescaux
Surgical intervention
8 years ago
1805 views
116 likes
0 comments
12:03
Laparoscopic left colectomy with transmesenteric colorectal anastomosis on the mid-transverse colon
The objective of this film is to show the totalization of a left partial colectomy performed one year ago and the possibility of doing a transmesenteric laparoscopic colorectal anastomosis. This patient had undergone a sigmoidectomy for sigmoid diverticulitis with a colorectal anastomosis one year ago. During the postoperative period, the patient had several subocclusive episodes and suffered from pain related to an ischemic stenosis of the lowered colon with no necrosis. The stenosis has become increasingly incapacitating, not only at the level of the anastomosis but especially at the level of the left colon, which has been getting narrower.
Laparoscopic surgery for transverse colon cancer
Laparoscopic surgery is feasible and safe in selected patients with rectal cancer, with favorable short-term and mid-term outcomes. Recently, results of large randomized controlled trials comparing laparoscopic with conventional open surgery have been published, demonstrating that laparoscopic surgery for colon cancer was equivalent to open surgery in terms of postoperative complications and long-term outcomes. In this lecture, Professor Junji Okuda presents the laparoscopic approach for transverse colon cancer and shows the port and patient positioning, precious technical details when performing splenic flexure dissection and anatomical notes along with a demonstration video.
J Okuda, N Tanigawa
Lecture
9 years ago
3397 views
33 likes
0 comments
10:47
Laparoscopic surgery for transverse colon cancer
Laparoscopic surgery is feasible and safe in selected patients with rectal cancer, with favorable short-term and mid-term outcomes. Recently, results of large randomized controlled trials comparing laparoscopic with conventional open surgery have been published, demonstrating that laparoscopic surgery for colon cancer was equivalent to open surgery in terms of postoperative complications and long-term outcomes. In this lecture, Professor Junji Okuda presents the laparoscopic approach for transverse colon cancer and shows the port and patient positioning, precious technical details when performing splenic flexure dissection and anatomical notes along with a demonstration video.
Totally laparoscopic right hemicolectomy with transvaginal specimen extraction
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.
S McKenzie, JH Baek, A Pigazzi
Surgical intervention
9 years ago
4448 views
103 likes
0 comments
08:30
Totally laparoscopic right hemicolectomy with transvaginal specimen extraction
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.
Laparoscopic right colectomy with Ligasure Advance® for ileocaecal mass in a young male patient
Endoscopic polypectomy still remains the cornerstone of therapy for colorectal polyps and adenomas. However, if colorectal polyps are too large or not accessible for endoscopic ablation or cannot be removed without an increased risk of perforation, operative procedures are required. In such circumstances, laparoscopic resection represents a minimally invasive alternative. The purpose of this film is to demonstrate our right colectomy technique, which respects oncological principles. The case is performed in a male patient with a BMI of 22 and presenting with a voluminous caecal mass with a lipoma found on biopsy. Because of its volume, a right colectomy has been decided upon.
J Leroy, J Marescaux
Surgical intervention
9 years ago
7744 views
175 likes
0 comments
17:41
Laparoscopic right colectomy with Ligasure Advance® for ileocaecal mass in a young male patient
Endoscopic polypectomy still remains the cornerstone of therapy for colorectal polyps and adenomas. However, if colorectal polyps are too large or not accessible for endoscopic ablation or cannot be removed without an increased risk of perforation, operative procedures are required. In such circumstances, laparoscopic resection represents a minimally invasive alternative. The purpose of this film is to demonstrate our right colectomy technique, which respects oncological principles. The case is performed in a male patient with a BMI of 22 and presenting with a voluminous caecal mass with a lipoma found on biopsy. Because of its volume, a right colectomy has been decided upon.
Laparoscopic right colectomy for cancer
Laparoscopic colorectal surgery has gained wide acceptance as a treatment in a variety of benign and malignant diseases. The reproducibility and safety of all the principal colorectal procedures has been demonstrated. Surgeons performing right hemicolectomy using the laparo-assisted technique consider it more difficult than open colectomy. It is possible to perform a completely laparoscopic right hemicolectomy in advanced laparoscopic centers with many benefits: less postoperative pain, short-term postoperative ileus, earlier return to daily activity. This chapter describes surgical anatomy, indications and techniques of laparoscopic right colon resection for cancer.
J Leroy, J Marescaux
Operative technique
9 years ago
85274 views
764 likes
5 comments
Laparoscopic right colectomy for cancer
Laparoscopic colorectal surgery has gained wide acceptance as a treatment in a variety of benign and malignant diseases. The reproducibility and safety of all the principal colorectal procedures has been demonstrated. Surgeons performing right hemicolectomy using the laparo-assisted technique consider it more difficult than open colectomy. It is possible to perform a completely laparoscopic right hemicolectomy in advanced laparoscopic centers with many benefits: less postoperative pain, short-term postoperative ileus, earlier return to daily activity. This chapter describes surgical anatomy, indications and techniques of laparoscopic right colon resection for cancer.
Laparoscopic segmental resection of the transverse colon
This video demonstrates the unusual procedure of segmental transverse colon resection performed for an adenocarcinoma in the distal part. All oncological principles are obeyed and a stapled colo-colic reconstruction is performed totally intracorporeally. This video is suitable for digestive surgeons.
The author opens the mesocolon in the shape of a V and uses the Harmonic scalpel to divide the mesocolic fat. Dissection proceeds from the base of the mesocolon towards the colon, where the author carefully isolates Drummond’s marginal artery. Attention then turns to complete the resection of the mesocolon on the right limb of the V. The author identifies the mesocolic vessels as they emerge from the superior mesenteric vessels. This approach requires care because of the number of major vessels in the area. The dissection continues upward to divide the mesocolon on the right side.
U Parini
Surgical intervention
11 years ago
450 views
81 likes
0 comments
09:40
Laparoscopic segmental resection of the transverse colon
This video demonstrates the unusual procedure of segmental transverse colon resection performed for an adenocarcinoma in the distal part. All oncological principles are obeyed and a stapled colo-colic reconstruction is performed totally intracorporeally. This video is suitable for digestive surgeons.
The author opens the mesocolon in the shape of a V and uses the Harmonic scalpel to divide the mesocolic fat. Dissection proceeds from the base of the mesocolon towards the colon, where the author carefully isolates Drummond’s marginal artery. Attention then turns to complete the resection of the mesocolon on the right limb of the V. The author identifies the mesocolic vessels as they emerge from the superior mesenteric vessels. This approach requires care because of the number of major vessels in the area. The dissection continues upward to divide the mesocolon on the right side.
Laparoscopic treatment for right colon cancer
This video demonstrates an uncomplicated laparoscopic right hemicolectomy in an obese lady with cecal cancer. The surgeon uses 4 trocars to achieve medial mobilization of the mesentery, divide the ileocolic at the root and then mobilize the right colon up to proximal transverse colon. The terminal ileum is divided intracorporeally and the specimen is retrieved through a right lateral skin crease muscle splitting incision. An extracorporeal stapled anastamosis is made and the mesenteric window is not closed.
This video is a good demonstration of key anatomic landmarks, surgical planes, and surgical approach to a right hemicolectomy for cancer using the medial approach.
T Rockall
Surgical intervention
12 years ago
5652 views
173 likes
0 comments
10:11
Laparoscopic treatment for right colon cancer
This video demonstrates an uncomplicated laparoscopic right hemicolectomy in an obese lady with cecal cancer. The surgeon uses 4 trocars to achieve medial mobilization of the mesentery, divide the ileocolic at the root and then mobilize the right colon up to proximal transverse colon. The terminal ileum is divided intracorporeally and the specimen is retrieved through a right lateral skin crease muscle splitting incision. An extracorporeal stapled anastamosis is made and the mesenteric window is not closed.
This video is a good demonstration of key anatomic landmarks, surgical planes, and surgical approach to a right hemicolectomy for cancer using the medial approach.