Laparoscopic Assisted Ileocolic Resection or Right Hemicolectomy


The first (10–12 mm) trocar is placed in the supraumbilical region at the incision line planned for the removal of the specimen. In some cases where infraumblical extraction is possible (depending on the pathology and the patient's body), this area can be used. Screwed trocars can sometimes be helpful in obese patients with a thick abdominal wall.

The 0 degree laparoscope of this trocar is entered.

Two 10–12 mm trocars are placed lateral to the rectus muscle in the left upper and lower left quadrants.

Additional trocars may be needed for retractors. These are usually placed in the right upper or lower right quadrants (again lateral to the rectus muscle). Sometimes a third additional trocar can be placed too high in the left upper quadrant.

The patient is given a vertical Trendelenburg position with the left edge of the table down.

It is located at the base of the terminal ileum and cecum. Concept of cecum with endoscopic Babcock type clamp.

It is cut along the white line of Toldt with ultrasonic scissors or electrocautery scissors and the right column is mobilized up to the liver level.

In cases where further medial dissection is required to expose the ureter, Gerota fascia and duodenum, the right column should be manipulated by grasping it constantly.

The hepatic flexure is grasped and the hepaticcocholic ligament is separated with ultrasonic or electrocautery scissors. Since bleeding may occur during the use of electrocautery scissors, ligaclips or endoclips should be ready.

Finally, grasping the transverse column, from the distal of the omentum majus gastroepiploic vessels, a. colica media level. Using ultrasonic scissors for this dissection is better than other methods.

As described above, when the right colon is fully mobilized, the cecum is grasped with the endoscopic Babcock clamp, which is passed through the selected area of ​​the playpiece to be removed. If necessary, the laparoscope is placed in one of the other trocar locations. It is necessary to return the small intestine in those with Crohn's disease. This maneuver is performed with the "hand-over-hand" technique using two Babcock clamps under direct vision.

Usually, a 2-5 cm vertical incision is made in the supraumblical region where the first trocar is placed.

A facial incision is made through the insulated sheath of the forceps (attached to the cecum). The collapse of the pneumoperitoneum is achieved.

The cecum is drawn through the midline incision and the terminal ileum, cecum, ascending and proximal transverse are removed over the remaining abdominal wall. Vascular ligation, bowel division, anastomosis, and closure of the mesenteric defect are performed as during laparotomy. Typically a stapled functional end-to-end anastomosis is performed. The mesenteric defect is closed as usual. Once the anastomosis is complete, the abdominal cavity is returned, with great care being taken not to damage the intestines or tear the mesentery during this manipulation. The incision is closed using intermittent absorbable sutures.

The pneumoperitoneum is reconstructed from one of the other trocar areas and the laparoscope is inserted.

Intestines, anastomosis and abdomen are checked; Irrigation should be done and make sure of hemostasis. Trocar places are covered as usual.

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