Right hemicolectomy, laparoscopically assisted

Skin incision left subcostal in the midclavicular line. Insertion of the Veress needle after local infiltration anesthesia; safety tests and establishment of the capnoperitoneum.

Removal of the Veress needle; spreading of the muscle using scissors and blunt insertion of the 10 mm trocar.
Laparoscopic exploration: Mild fibrotic changes on the liver surface; the cecum carcinoma is adherent in a small area to the parietal peritoneum of the lateral abdominal wall.

Insertion of two 5 mm trocars in the left mid-abdomen in the midclavicular line and in the left lower abdomen paramedian – each under diaphanoscopy, local infiltration anesthesia, and skin incision – under direct vision. Trendelenburg positioning and left tilt of the table, shifting the small intestine to the left upper abdomen.

Tensioning of the mesentery at the ileocecal junction and thus locating the ileocolic vessels. Dissection of the origin of the ileocolic artery from the superior mesenteric artery. Also, dissection of the venous origin.

Transect the ileocolic artery between Lapro-Clips® after additional sealing of the central vessel using LigaSure™ V. Subsequently, also transect the corresponding vein with sealing using LigaSure™ V.

Layered dissection of the mesocolon or mesentery from the retroperitoneum with visualization and preservation of the duodenum, respecting the Gerota's fascia as the boundary layer. Determination of the oral resection margin.

Releasing the mesenteric adhesions of the terminal ileum from the lateral side for complete mobilization of the small intestine while visualizing and preserving the right ureter.

Transecting the mesentery from the centrally isolated A. ileocolica to the planned resection margin of the terminal ileum while sealing with the LigaSure™ V.

Completion of the continued layer-appropriate mobilization of the right hemicolon from the medial side. Centrally expose and transect the right colic artery after secure sealing using LigaSure™ V..
[The right colic artery originates from the middle colic artery shortly after its departure from the superior mesenteric artery].

Sealing and transection of the transverse mesocolon to the right of the middle colic artery up to the planned resection margin at the transverse colon.