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Right hemicolectomy, laparoscopically assisted
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Surgically relevant anatomy
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Transverse colon
- Synonym: Colon transversum
- Location: Intraperitoneal; mobile fixation via its own mesentery - transverse mesocolon.
- Identification: By the so-called
taeniae = taeniae coli = condensations of longitudinal muscle fibers named according to their anatomical relations as - taenia libera (inferior)
- taenia omentalis (greater omentum)
- taenia mesocolica (transverse mesocolon)
- omental appendices = fat-filled tunica serosa
- Haustrae of colon = haustrae coli = visible sacculations in the wall of the colon wall by the arrangement of the circular muscle fibers (plicae semilunares; evident on endoscopy) which are discernible on the outer wall as crescentic folds.
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Ascending colon
- Definition: Section of the large bowel from the ileocecal valve, where the small intestine (ileum) enters the colon, to the hepatic (right) flexure.
- Synonym: Colon ascendens
- Location: secondary] retroperitoneal - peritoneal fixation to the posterior abdominal wall by the so-called Toldt membrane
- Identification: By the longitudinal bundles of muscle fibers- the taeniae, which keep their location-related terminology from the transverse colon; the diameter is markedly larger than that of the descending colon!
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Cecum
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Skin incision and Verres needle insertion
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Inserting the 10mm trocar; diagnostic laparoscopy
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Inserting the 5mm trocars; patient positioning
Insert two 5mm trocars in the mid-abdomen in the left medioclavicular line and paramedian in the left lower abdomen - each under view after transillumination, infiltration of local anesthetic and skin incision.
Trendelenburg positioning and left tilt of the table will displace the small intestine into the left upper quadrant. -
Dissecting the ileocolic vessels
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Dividing the ileocolic artery and vein
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Dividing mesocolon and mesentery
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Mobilizing the terminal ileum
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Dividing the mesentery
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Dividing the right colic artery
Complete the layered mobilization of the right hemicolon from mediad while respecting the correct layer.. Expose the central trunk of the right colic artery and divide it with the LigaSure™ V.
The right colic artery arises from the middle colic artery shortly after it departs from the superior mesenteric artery. -
Dividing the transverse mesocolon
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Opening the omental bursa
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Dividing the peritoneal reflection
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Freeing the cecum
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Right supraumbilical minilaparotomy; exteriorizing the right hemicolon
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Transecting the right hemicolon
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Hand-sewn end-to-end anastomosis
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Checking and interiorizing the anastomosis
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Suturing the fascia of the minilaparotomy
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Laparoscopic check
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Closing the mesenteric defect and irrigating the abdominal cavity
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Removing the trocars and suturing the fascia; subcuticular skin suture and dressing
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Literature summary
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Ongoing trials on this topic
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References on this topic
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Reviews
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Guidelines
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literature search
Literature search under: http://www.pubmed.com