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

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.

Technique

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Media Gallery

Trocar site placement.
Grasper placement.
Variations of the right colic artery anatomy.
Arterial supply of the right colon.
Right colon mobilization.
Transverse colon mobilization.
Control of mesentery and proximal margin.
Ileocolic anastomosis.
Single-incision right hemicolectomy performed with laparoscopic instruments. Video courtesy of SAGES.

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Author

Jana L Lewis, MD Resident Physician, Department of Surgery, Maimonides Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Danny A Sherwinter, MD Attending Surgeon, Department of Mimially Invasive Surgery and Bariatrics, Associate Program Director, Department of Surgery, Maimonides Medical Center; Director of Minimally Invasive and Bariatric Surgery, American Society for Metabolic and Bariatric Surgery (ASMBS) Center of Excellence

Danny A Sherwinter, MD is a member of the following medical societies: American College of Surgeons, American Society for Metabolic and Bariatric Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoscopic and Robotic Surgeons

Disclosure: Nothing to disclose.

Sunny Leah Fink, MD Multi-Organ Abdominal Transplant Fellow, Department of Transplant Surgery, University of Pittsburgh Medical Center

Sunny Leah Fink, MD is a member of the following medical societies: American College of Surgeons, American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Silvio Ghirardo, MD Resident Physician, Department of General Surgery, Maimonides Medical Center

Disclosure: Nothing to disclose.

Sergey Terushkin, MD Bariatric and Minimally Invasive Surgery, New York

Sergey Terushkin, MD is a member of the following medical societies: American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Harry L Adler, MD Assistant Clinical Professor of Surgery, Mount Sinai Hospital; Assistant Director and Consulting Physician, Maimonides Medical Center

Harry L Adler, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Surgeons, Association for Academic Surgery

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Associate Professor, Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine; Chair, Department of Surgery, Saint Francis Hospital, Trinity Health of New England Medical Group

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoscopic and Robotic Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Maimonides Medical Center Group would like to thank Courtney Schlow for creating the above illustrations.

Medscape Reference thanks SAGES for the single incision right hemicolectomy video in this article.