COLORECTAL   > Laparoscopic Radical Right Hemicolectomy

Patient and Port position: Patient placed in modified Lloyd Davies position.
Pneumoperitoneum is created by veress needle through 10 mm Supraumbilical skin incision which later on is converted into 10mm camera port.  10mm suprapubic, 12mm LIF, 5mm RIF and epigastric ports are made.

STEPS:
Initial step is to visualize all quadrants of peritoneal cavity, liver surfaces, pelvis and primary tumor location for metastasis, lymphadenopathy and ascites. Retro caceal tunnel created between right mesocolon and fascia of Gerota. During mobilization, the right ureter, spermatic vessels and duodenum is identified. Initial retroperitoneal dissection facilitates easy control of vascular pedicle and clearance of lymph nodes and vessels. The peritoneum of mesentry is incised over the SMA close to origin of its branches. iIleocolic and right colic vessels dissected, clipped at their origin and divided.The incision over the mesentery is continued over the transverse mesocolon till the proposed line of division of Transverse Colon and the right branches of middle colic vessels are divided. Gastrocolic ligament is divided and  lesser sac opened. The hepatocolic ligament is incised till hepatic flexure. Finally the lateral attachment of the colon is divided from caecum upto hepatic flexure along white line of Toldt. Ileum divided 20cm proximal to IC junction and colon right to middle colic vessels by endo GIA stapler.  Intracorporeal ileotransverse anastomosis done by Endo GIA stapler. Enterotomy closed by 3-0 PDS sutures. 5cm transverse suprapubic incision given and specimen taken out.