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Laparoscopic Right Hemicolectomy by Nezar Jrebi, MD and Jay Redan, MD
Authored by
Nezar Jrebi, MD and Jay Redan, MD
Authored by
Nezar Jrebi, MD and Jay Redan, MD
Laparoscopic Right Hemicolectomy by Nezar Jrebi, MD and Jay Redan, MD
Operative Steps
Operative Steps
- Trocar sites are identified, and trocars inserted to gain access to the abdominal cavity.
- Initial Access to the abdomen is generally obtained by either:
- Veress needle technique.
- Direct trocar view technique.
- Explore the abdominal cavity, assessing the liver and peritoneal surfaces.
- Take down any adhesions.
- Gain access to and mobilize the cecum and ileum by ligating and dividing the ileocolic artery and ileocolic vein to their origins at the base of the mesentery, using an energy device such as ENSEAL™ X1 Curved Jaw Tissue Sealer or a stapling device such as ECHELON™ 3000 Stapler.
- Ensure a complete specimen with intact mesocolic envelope containing all lymph nodes, extract specimen.
- Identify duodenum.
- Identify right ureter.
- Continue mobilization and dissect the hepatic flexure and right transverse colon mesentery by ligating and dividing the right middle colic vessels using an energy device such as ENSEAL™ X1 Curved Jaw Tissue Sealer.
- Transect distal ileum proximal to the ileocecal valve, using a stapling device, such as PROXIMATE™ Linear Cutters, and ensuring adequate blood supply to the remaining ileum.
- Transect the proximal end of the right transverse colon, using a stapling device such as PROXIMATE™ Linear Cutters, and ensure adequate blood supply to the remaining colon by utilizing laser camera and ICG.
- Perform a side to side or end to side anastomosis, using a stapling device such as PROXIMATE™ Linear Cutters.
- Check the anastomosis for bleeding and leakage.
- Close the common enterotomy using a stapling device or suture such as Monocryl™ Plus Antibacterial suture or STRATAFIX™ Spiral MONOCRYL™ Plus Knotless Tissue Control Device and reinforce the staple line intervention if applicable.
- Generally, a closing tray and new gown and gloves are used to lower surgical site infection.
- Remove fluid from wound and close the fascia using suturing device such as STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device.
- Subcuticular layer and skin are closed using synthetic absorbable monofilament, such as Monocryl™ Plus Antibacterial suture, and a topical skin adhesive such as DERMABOND PRINEO™ Skin Closure System or any appropriate dressing.
- Inject wound with a local anesthetic.
Potential complications include but are not limited to:
- Surgical bleeding
- Staple line Leak
- Wound infection
- Ileus
- Urinary retention