Hemicolectomy right, open - general and visceral surgery

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  • Laparotomy

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    69-4

    Midline abdominal incision passing the umbilicus on the right.
    Transection of the subcutaneous tissue and fascia with monopolar diathermy.

  • Bladder catheter / Setting up the surgical field

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    After transection of the peritoneum, insert a suprapubic catheter into the bladder.
    Set up the surgical field with the retractor system.

  • Exploration

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    Gain an overview of the size and extent of the tumor and any abdominal metastases.

  • Mobilizing the ascending colon

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    69-7

    First incise the peritoneum lateral to the cecum and ascending colon, then free the ascending colon in the avascular layer from the retroperitoneum anterior to the right kidney.

  • Mobilizing the mesenteric root

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    69-8

    First, completely mobilize the ascending colon with the root of the mesentery up to the duodenum, then free the duodenum and mobilize the head of the pancreas.

  • Kocher maneuver

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    Free both the duodenum and pancreatic head extensively from the vena cava

  • Dissecting the duodenum

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    Dissect the duodenum off the ascending mesocolon and mesenteric root.

  • Opening the omental bursa

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    Divide the greater omentum off the greater curvature of the stomach along the antrum while taking down the vascular arcades close to the gastric wall including the gastroepiploic arcade. At the downstream margin of resection split the greater omentum longitudinally.

  • Dissecting the peripancreatic lymph nodes

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    Additional lymph node dissection at the pancreatic head with division of the right gastroepiploic vessels.

  • Dividing the ileocolic artery and vein

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    First divide the ileocolic artery close to its origin and then the ileocolic vein. Dissect along the root of the mesentery.

  • Dividing the right colic artery

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    Divide the right colic artery This completes the dissection at the mesenteric root.

  • Dividing the ileum

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    Divide the marginal arcade of the terminal ileum, followed by transection of the ileum 10 cm upstream of the ileocecal valve.

  • Dividing the colon

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    Divide the marginal vascular arcade of the colon between clamps. Transect the transverse colon with monopolar diathermy.

  • Managing the resected specimen

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    Remove the specimen and send to histopathology.

  • Ileotransversostomy

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    End-to-end ileotransversostomy with single layer extramucosal running suture.

  • Closing the mesenteric defect

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    Running suture of the mesenteric defect with Vicryl® 3/0.

  • Robinson drain

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    Insert an intraabdominal Robinson drain for the ascites present.

  • Closing the fascia

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    Through-and-through running suture of the fascia with Vicryl® 2.

  • Redon drain

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    Insert and anchor a subcutaneous Redivac drain.

  • Closing the skin

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    Close the skin with interrupted vertical mattress sutures 3/0; sterile adhesive dressing.

  • Dressing

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