Transcript Techniques of laparoscopic right hemicolectomy: cancer and Crohn

Techniques of laparoscopic right
hemicolectomy: Cancer and Crohn disease
Ass. Prof. Zdravko Perko
Indication
• Cancer / carcinoid
• Crohn disease
• Cecal tumors
• Cecal necrosis ....
Trocar positioning
• based on the experience and preference
of the individual surgeon
• RIGHT HEMICOLECTOMIES
– four trocars (50%), 3 trocars (30%), 5
trocars (20%)
• specimen extraction
– at the site of the umbilical trocar, subcostal
incision, upper medial incision
– Crohn – right lateral (split) incision
Right colon
patient position - op setup
Trocar position
– At the umbilicus 10-12mm trocar is placed
– A 10mm trocar is placed suprapubically
– The epigastric region by 70% of authors
– Some experts place a 5mm trocar at the left
iliac fossa or at the right subcostal space.
Trocar position
Right colon - trocars
Right / Transverse colon
patient position - op setup
Right / Transverse colon
trocar placement
Right colon - procedures
Crohn disease
lap assisted procedures
Stricturoplasty
Anatomical features
Right colon carcinoma
Right colon carcinoma
Right colon - exposure
Right colon – medial approach
Right colon – anatomical relationships
Right colon
anatomical relationships
Right colon – anatomical relationships
Right hemicolectomy
• Medial / lateral approach
• Blood vessels
• Urether / duodenum injury
• Ileocolic artery transsection
– Right / medial colic art. transection
• Extracorporeal anastomosis
Extracorporeal anastomosis
• Incision
– Upper medial, umbilical, subcostal
• Final dissection
– Vessels transection, great omentum
• Anastomosis
– End-to-end, end-to-side, side-to-side
– Suture mesenteric gap
– drainage
Postoperative course
• No NGT
• Liquid diet on the day of op
• Encourage mobilisation
• .....