Right hemicolectomy

Median midline laparotomy with right-sided umbilical incision. Transection of subcutaneous fat tissue and fascia with monopolar diathermy.

After transection of the peritoneum, insertion of a suprapubic bladder catheter. Positioning of the surgical site with the retractor system.

Overview of the size and extent of the tumor and abdominal metastases.

The preparation of the right hemicolon is performed from lateral to medial and begins with the incision of the peritoneum lateral to the colon. This allows direct access to the slit-like space between the parietal fascia covering the retroperitoneal organs and the mesenteric/visceral fascia that extends continuously over all intraperitoneal organs.

From the dorsal side, the mesocolon is now mobilized with the entire mesenteric root towards the ventral side.

By preparing along the dorsal leaf of the mesocolic fascia and strictly avoiding injury to the ascending mesocolon, the mesenteric root is reached under complete mobilization of the ascending colon. This allows controlled access to the superior mesenteric vein with the veins draining there and the origin of the colonic arteries.

The mobilization plane extends along the dorsal layer of the mesocolon to beneath the duodenum with the pancreatic head, resulting in a Kocher maneuver. The duodenum and pancreatic head are also covered by the visceral fascia, the mesoduodenum, and mesopancreas. This mesoduodenum is separated from the parietal fascial layer, which covers the vena cava and aorta.

Note: At the end of the video, the surgeon demonstrates the detachment of the mesenteric layer, here the mesoduodenum and mesopancreas, from the parietal layer covering the vena cava and aorta. 

Next, the duodenum is dissected from the ascending mesocolon dorsally by detaching the dorsal fascia of the mesocolon from the duodenum and the head of the pancreas. This provides complete access to the mesenteric root from the right side.

Detachment of the greater omentum from the greater curvature of the stomach along the antrum with close-to-stomach transection of the vascular arcades, including the gastroepiploic arcade, thereby opening the omental bursa. Longitudinal splitting of the greater omentum at the aboral resection margin. The wide access to the omental bursa ensures good exposure of the colic media vessels.

Note: If the omentum has no contact with the tumor, it is not necessary to perform an omentum resection in carcinomas of the cecum and ascending colon.