Full Robotic Right Colectomy with Intracorporeal Anastomosis

Paolo Pietro Bianchi (Grosseto – Italy) Wanda Petz (Milano – Italy) L. Casali, M. Parodi, D. Belotti

Minimally invasive surgery is an established treatment for resectable colon cancer. Robotic approach may offer some technical advantages in comparison with standard laparoscopy. The video shows technical aspects of full robotic right colectomy with intracorporeal anastomosis. The patient is positioned in dorsal decubitus with the table is in slight Trendelemburg and 10 degrees left rotation; the robotic cart comes from the patient’s right shoulder. Five trocars are inserted: one, left paraumbilical, for the optical system, three robotic (sovrapubic, subxiphoid and in left hypochondrium) and one accessory in the left flank. After a laparoscopic abdominal exploration with hepatic ultrasonography, robotic arms are connected. With the third robotic arm retracting the transverse mesocolon cranially, ileocolic vessels are identified and separately sectioned at the origin between clips. Vascular dissection proceeds cranially with progressive isolation and ligation of right colic vessels and right branches of middle 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 dissected to the prefixed transection points on the transverse colon and the ileum; then bowel transection is performed by linear endostapler. An intracorporeal side to side mechanical anastomosis is performed, a manual running suture is realized to close the stapler insertion holes and the specimen is extracted through a Pfannenstiel mini-laparotomy.