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Laparoscopic D3 lymphadenectomy for right-sided colon cancer

Laparoscopic D3 lymphadenectomy for right-sided colon cancer.
D-r Puchkov D.K. (CMS) is performing an operation (2018).

In this film the technique of performing D-3 lymphadenectomy (operation stage) for right-sided colon cancer is presented. A 50 year-old male patient was treated with diagnosis: Cancer of hepatic flexure of colon fT3N1M0, G2. During preoperation investigation, on RCT research a few findings was detected: a big formation in the transverse colon, closer to the hepatic flexure about 5 cm in diameter, there were multiple increased lymphatic nodes in the mesentery of the ascending colon, without sings of metastatic lesion. There is no RCT information about local spreading of tumour. The first stage of operation: a 10 mm troacar was placed above the umbilicus and then 10 mm optic was introduced. Then a 5 mm troacar was introduced into epigastrium along the midline of abdomen under the guidance of optic and then 5 mm troacars were introduced into the right and left iliac area. During the revision of the abdominal cavity where was no evidence for liver metastases. The tumour was located in the proximal one-third of the transverse colon, is movable, firm, does not invade the serous layer, increased paracolic lymphatic nodes. Taking into consideration the intraoperation situation of the patient, we decided to perform a right hemicolectomy with D3 lymphadenectomy, high ligation of main arteries and veins. V.ileocolica was visualized, skeletonized and transected at the origin into the superior mesenteric vein with a 5 mm LigaSure (“Medtronic Covidien”) device, a. ileocolica is ligated in the origin of the superior mesenteric artery. Then the right part of the colon was mobilized from “downwards-to upwards” within the Toldt’s fascia by Harmonic Scalpel (“Ethicon”) device, a descending part of duodenum is visualized. The head of pancreas, infrapyloric lymphatic nodes were intact. Lymphatic nodes along the superior mesenteric artery and vein were removed. The operation is continued. Mesocolonectomy has been performed. The duration of this stage was 50 minutes.



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