Right hemicolectomy, laparoscopically assisted - general and visceral surgery

Subcostal skin incision in the left medioclavicular line. Following infiltration of local anesthetic; insert the Verres needle; perform the safety tests and create the pneumoperitoneum.

Remove the Verres needle; split the muscles with scissors and bluntly insert the 10mm trocar.
Laparoscopic exploration: Minor fibrotic changes of the liver surface; small areas of adhesion of the cecal cancer with the parietal peritoneum at the lateral abdominal wall.

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.

Stretching the mesentery at the ileocecal junction will pinpoint the ileocolic vessels.
Free the ileocolic and superior mesenteric arteries at their origins. Then free the venous junctions.

Divide the ileocolic artery between Lapro-Clips® after also sealing its central trunk with the LigaSure™ V. Follow this by transecting the ileocolic vein after sealing it with the LigaSure™ V.

Divide the mesocolon / mesentery off the retroperitoneum respecting the correct layer while exposing and preserving the duodenum and sparing the boundary of the Gerota fascia. Determine the proximal resection margin.

Free the right lateral mesenteric adhesions of the terminal ileum until the small intestine is completely mobile while exposing and sparing the right ureter.

With the LigaSure™ V divide the mesentery from the central transection of the ileocolic artery to the planned resection margin of the terminal ileum.

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.

Seal and divide the transverse mesocolon to the right of the middle colic artery up to the planned resection margin on the transverse colon.

Free the greater omentum from the transverse colon while opening the lesser sac.

Divide the peritoneal reflection first at the hepatic flexure and then complete its release by dividing the reflection along the right paracolic gutter.

With the monopolar hook tip electrode free the cecum from the abdominal wall including the parietal peritoneum and a layer of preperitoneal fatty tissue - without opening the tumor. The right hemicolon is now fully mobilized.

Transverse transrectal supraumbilical minilaparotomy on the right and insertion of the 7cm ring drape for wound edge protection. Exteriorize the right hemicolon through the minilaparotomy.

Ring the delivered right hemicolon with towels soaked in Lavanid® solution and sparingly skeletonize both resection margins. Apply crushing intestinal clamps on the specimen side and hand off to histopathology.

Coagulate point bleeders on both stumps and slit the ileal stump on its antimesenteric aspect to create matching lumina of both colon and ileum. Hand-sewn end-to-end anastomosis with one-layer inverting extramucosal continuous suture, PDS 4/0.

Check the non-bleeding tension-free and rotationally correct anastomosis with its still excellent blood supply for non-leakage and patency.
Remove the towels and interiorize the anastomosed parts of the bowel.

Close the fascia with a two-layer continuous suture PDS 2/0.

Recreate the pneumoperitoneum and once again check the field for continued dryness.

Close the mesenteric defect with a continuous suture Vicryl® 3/0 without compromising the blood supply of the anastomosis. Thoroughly irrigate the entire abdominal cavity once more - under view - and suction the clear irrigation fluid.