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 - 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

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.....