NOSE Lap Right Colectomy

Technique Description:

• Laparoscopic 4 trocar approach
• High vessels ligation with SMV exposure
• Intracorporeal Anastomosis
• Colpotomy and transvaginal specimen extraction

Procedure Steps:

• 1. Trocar insertion.
• 2. High ligation of Ileocolic vessels.
• 3. Exposure of SMV.
• 4. Dissection of Toldt’s fascia.
• 5. Section of transverse colon and terminal Ileum.
• 6. Intracorporeal stapler anastomosis
• 7. Colpotomy and transvaginal specimen extraction
• 6. Vaginal Suture

Learning Points:

• Oncologic Right colectomy even without formal CME
• Intracorporeal anastomosis
• Natural orifices specimen extraction

Clinical History:

• 82-year-old female
• No significant past medical history
• Recent significant anemia (Hb 7.8 g/dl)
• Colonoscopy sub-stenotic lesion at the cecum
• Adenocarcinoma
• Thoraco-Abdominal CT Scan: no distant metastases