Right hemicolectomy, laparoscopically assisted - general and visceral surgery

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  • Skin incision and Verres needle insertion

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    Skin incision and Verres needle insertion
     

    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.

  • Inserting the 10mm trocar; diagnostic laparoscopy

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    Inserting the 10mm trocar; diagnostic laparoscopy
     

    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.

  • Inserting the 5mm trocars; patient positioning

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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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    Dissecting the ileocolic vessels
     
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  • Dividing the ileocolic artery and vein

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    Dividing the ileocolic artery and vein
     
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  • Dividing mesocolon and mesentery

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    Dividing mesocolon and mesentery
     
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  • Mobilizing the terminal ileum

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    Mobilizing the terminal ileum
     
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  • Dividing the mesentery

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  • Dividing the right colic artery

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  • Dividing the transverse mesocolon

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  • Opening the omental bursa

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

  • Dividing the peritoneal reflection

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

  • Freeing the cecum

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    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.

  • 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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