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Published byWilfred McKenzie Modified over 9 years ago
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Techniques of laparoscopic right hemicolectomy: Cancer and Crohn disease Ass. Prof. Zdravko Perko
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Indication Cancer / carcinoid Crohn disease Cecal tumors Cecal necrosis....
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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
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Right colon patient position - op setup
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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.
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Trocar position
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Right colon - trocars
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Right / Transverse colon patient position - op setup
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Right / Transverse colon trocar placement
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Right colon - procedures
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Crohn disease lap assisted procedures
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Stricturoplasty
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Anatomical features
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Right colon carcinoma
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Right colon - exposure
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Right colon – medial approach
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Right colon – anatomical relationships
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Right colon anatomical relationships
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Right colon – anatomical relationships
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Right hemicolectomy Medial / lateral approach Blood vessels Urether / duodenum injury Ileocolic artery transsection –Right / medial colic art. transection Extracorporeal anastomosis
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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
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Postoperative course No NGT Liquid diet on the day of op Encourage mobilisation.....
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