Laparoscopic Right Colectomy with Intracorporeal Anastomosis

Paolo Pietro Bianchi (Grosseto – Italy)

Summary: The video shows technical aspects of laparoscopic right colectomy with an intracorporeal anastomosis. The patient is positioned in dorsal decubitus with legs closed and arms along the body, the operative table is in 5 degrees Trendelemburg position and 10 degrees left side rotation. Four trocars are inserted: one, left paraumbilical, for the optical system, three operative: suprapubic, subxiphoid and in left hypochondrium. A laparoscopic ultrasonography of the liver is performed to complete intraoperative staging. The transverse mesocolon is retracted cranially by the assistant then ileocolic vessels are identified and separately sectioned at the origin between clips. Vascular dissection proceeds cranially with isolation and ligation of right colic vessels. The duodenal plane and the venous Henle trunk are identified and respected. Colo-epiploic detachment permits to mobilize the hepatic colic flexure. The transverse mesocolon and the mesentery are then sectioned until the prefixed section points on the transverse colon and the ileum; intestinal section is performed by linear endostapler. A side to side mechanical anastomosis is performed and a running suture is realized to close the stapler insertion points; the specimen is then extracted through a Pfannenstiel mini-laparotomy.