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Colon cancer
Laparoscopic right hemicolectomy
Автор: Puchkov D.K.
Laparoscopic right hemicolectomy.
D-r Puchkov D.K. (CMS) is performing an operation (2018).
• In this video the technique of laparoscopic right hemicolectomy is presented. A 53 year-old female patient was operated with diagnosis: Cancer of the hepatic flexure of the colon fT3N0M0, G2. During preoperation investigation of the abdominal cavity according to RCT, was found extensive formation about 5.5 cm in diameter and multiple increased lymphatic nodes along the artery ileocolica, without symptoms of their metastatic lesion. The first stage of operation: a 10 mm troacar was placed above the umbilicus, 10 mm optic was introduced. Then a 5 mm troacar was introduced in epigastrium along the midline of abdomen under the guidance of optic, 5 mm troacars were introduced into the right and left iliac areas. During revision of the abdominal cavity where was not found any sings of metastases in liver. The tumour was found in the cecum, movable, firm, does not involve the serous layer. Increased lymphatic nodes of the first priority were visualized. Intraoperatively surgeons decided to perform a right hemicolectomy with the high ligating of artery and vein ileocolica. Artery and vein were visualized, skeletonized, transected near the area of its origin with 5 mm LigaSure (“Medtronic Covidien”) device. The right part of the large colon was mobilized from “downwards-to- upwards” within the boundaries of Toldt’s fascia with Harmonic (“Ethicon”) scalpel, the descending part of duodenum was visualized, the head of pancreas, infrapyloric lymphatic nodes are intact. The abdomen of the right lateral canal was transected, resection of gastrocolic ligament up to the level of middle one-third of the transverse colon was done. Mesentery of the colic colon was mobilized up to the level of middle one-third of the transverse colic colon. Mesentery of the iliac colon was transected at the distance of 15 cm proximally to Bauhin’s (ileocecal) valve. Middle minilaparotomy was performed. Latex ring “Dextrus” was placed into the wound to restrict tissues of the anterior abdominal wall from the colon with tumour, the colon is exteriorized into the wound, resection of the right parts of the colon and iliac colon was done. Bistapler ileotransversoanastomosis “side –by-side” was performed. Edges of anastomosis were additionally stitched by “Vicryl” 3-0 thread. The abdominal cavity was drained via troacar incision in the right iliac area. Minilaparotomic and troacar wounds were stitched layer by layer. Aceptic bandage was applied. Operation duration is 80 minutes.
Laparoscopic right hemicolectomy
Автор: Puchkov D.K.
Laparoscopic right hemicolectomy D-r Puchkov D.K. (CMS) is performing an operation (2018).
A 61 year-old female patient was treated with diagnosis: Cancer of the hepatic flexure of the colon fT2N0M0, G2. During preoperation investigation of the abdominal cavity an extensive mass about 3.5 cm in diameter had been found out in the hepatic flexure of the colon according to the results of RCT. No lymph nodes were involved. The first stage: incision was done in paraumbilical area-3 cm. Platform QuadroPort+ (“Olympus”)was introduced into the abdominal cavity for performing one-port operation, CO2 gas was used for peritoneum. A 10 mm laparoscope, a 5 mm soft straight forceps and 5 mm curved forceps (“Medtronic Covidien”) and Harmonic scalpel device was introduced into the port. Firstly adhesion was separated. A. ileocolica was visualized, skeletonized and transected at the origin with 5 mm LigaSure (“Medtronic Covidien”) device. Then right part of the large colon was mobilized “downwards-to-upwards” within the boundaries of Toldt”s fascia with Harmonic Scalpel (“Ethicon”) device, descending part of duodenum and the head of pancreas were visualized. The peritoneum of the right lateral canal was transected, the gastrocolic ligament was resected up to the level of middle one-third of the transverse colon. Mesentery of the colon was mobilized up to the level of middle one-third of the transverse colic colon. Mesentery of the iliac colon was transected at the 10 cm proximally to Bauhin’s valve. The platform QuadroPort+ was removed from the abdominal cavity, resection of the right parts of the iliac and colon was done. Bistapler ileotransversoanastomosis “side-by-side” was formed. Anastomosis edges were additionally stitched by “Vicryl” 3-0 thread. The abdominal cavity was drained. Minilaparotomic wound was stitched layer by layer. Aceptic bandage was applied. Operation was about 145 minutes.
