Introduction:Feasibility and safety of laparoscopic onocological colectomy is now walidated. Aim ef this paper is to show technical details of totally laparoscopic right colectomy for cancer.
Methods:The patient is in supine position with right arm alongside the body.Three troacars are used:One 10mm periumbilical port which a 30 degree camera is introduced after apropriate CO2 insuflation,two left sides port:one 10mm in the left iliac fossa and one 12mm in the left upper quadrant.A lateral to medial approach with an early vascular control is the technique applied.The peritoneal layer is opened at the level of the duodenum and the space anterior to the Toldt s fascia is sharply dissected and the ileocolic vessels are isolated and divided.After division of the right colic vessels the ileum is transected vith a blue cartridge linear stapler.The right paracolic gutter colonic attachements are divide,the right flexure is completely mobilized and the transverse colon is transected with a 45 mm blue cartridge linear stapler .A side-to-side ileo-colic anastomosis is performed with a 45 mm blue or green cartridge linear stapler and the defect is closed with an intracorporeal running suture.Finally the specimen is placed within an endobagand extracted through a suprapubic minilaparotomy.
Results:From 2005 to april 2009,31patients mean ages 66 years ,with histologycally proven cancer have been treated by a totally laparoscopic right hemicolectomy.The mean operative time was 110min.No intraoperative complication were registered.The mean time of bowel movement was 2 days and the mean hospital stay was5 days.The mean number of lymph node s harvested was 18.
Conclusion:Totally laparoscopic treatment of the right colon cancer is safe adn radical.Otgher studies are necessary to determine the advantages of this technique in comparison with laparoscopy with the extracorporeal anastomosis or wit open technique.
Program Number: P121