Laparoscopic Right Colectomy (Right Hemicolectomy) Periprocedural Care

Updated: Oct 15, 2015
  • Author: Jana L Lewis, MD; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Equipment

Equipment used for laparoscopic right colectomy (right hemicolectomy) includes the following:

  • A light source with two video monitors for the surgeon and assistant
  • A 30° laparoscope
  • Standard gas insufflation equipment
  • Hasson trocar
  • Two 5-mm trocars and one 12-mm trocar
  • Three bowel-safe graspers
  • Laparoscopic ultrasonic shears (eg, Harmonic Scalpel, Sonosurg)
  • Electrocautery equipment
  • Laparoscopic suction irrigator
  • Laparoscopic clip applier
  • Medium wound protector
  • Laparoscopic linear cutting stapler with both white and blue reloads (eg, Echelon 60 mm or EndoGIA 60 mm)
  • Standard 75-mm gastrointestinal anastomosis (GIA) stapler with two blue reloads
  • Linear noncutting (eg, TA) stapler (60 mm) with a single blue load
  • Foley catheter
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Patient Preparation

Anesthesia

General anesthesia is required for a laparoscopic right hemicolectomy.

Antibiotic prophylaxis is recommended for prevention of surgical site infections. The recommendation is that this be administered by the anesthesiologist as a single dose prior to the skin incision.

Positioning

Confirm and mark the surgical site preoperatively in the holding area. Shave the surgical site with electric clippers. Prepare and drape the surgical site in the standard surgical fashion, exposing an area from below the xiphoid to above the pubis. The prepared area should be wide enough to allow conversion to an open technique, if necessary.

The patient is placed in a supine position, and straps are used to secure the patient during steep changes of table position. The patient’s left arm is tucked along his or her side and the right arm extended on an arm board.

A urinary catheter is placed in the bladder, and the stomach is decompressed with an orogastric tube.

The positioning of the surgical personnel varies, but the authors recommend the following. The nurse is on the patient’s right side. This is also where the assistant starts, with the surgeon on the patient's left side facing the right colon. Once all the trocars are in place, the assistant moves to the patient's left side to direct the camera and to help with retraction.

Monitor placement is crucial. One monitor should be placed at the right side of the patient so that the surgeon who is positioned on the left has an unobstructed view. A second monitor can be placed at the left side to help the assistant during insertion of the first trocar and to help the nurse follow the procedure.

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