Laparoscopic Right Hemicolectomy

Case Record:

• Male, 86 years old

• Unresectable polyp of the cecum with HGD

Clinical History:

• 86-year-old male patient, diagnosed with an unresectable polyp of the cecum after diagnostic colonoscopy.

• Biopsy: high-grade dysplasia

• Proposed for pre-habilitation followed by conventional laparoscopic Right Colectomy.

Other History:

• Medical History: Hypertension, Type 2 Diabetes, Atrial Fibrillation, Heart Failure, Stage III Chronic Kidney disease, Pulmonary dysfunction

• Surgical History: no previous surgeries

Procedure Steps:

1. Construction of the pneumoperitoneum with Veress needle

2. Placement of an umbilical optical trocar followed by 4 working trocars: 5mm epigastrium and right upper and lower quadrants, 12 mm hypogastrium

3. Inspection of the abdominal cavity

4. Approach of the ileocolic vessels in a medial-to-lateral approach and ligation about 1cm from the origin

5. Dissection of the posterior plane without disruption of the mesocolic fascia and leaving the duodenum and right ureter.

6. Dissection of the mesocolon and mesentery of the terminal ileum

7. Transection of the transverse colon and the terminal ileon and construction of an antiperistaltic latero-lateral stappled anastomosis after confirmation of vascularization with ICG.

8. Trocar revision and extraction of the specimen.

Learning Points: