CHAPTER 21 Right hemicolectomy
Step 1. Surgical anatomy
♦ The ileocolic vascular pedicle of the superior mesenteric artery must be isolated and divided. If the resection is performed for malignancy, it is important to divide this pedicle close to the root of the mesentery.
♦ The mesenteric vessels should be divided up to and including the right branch of the middle colic artery for a formal right hemicolectomy.
Step 2. Preoperative considerations
Patient preparation
♦ A preoperative colonoscopy will identify the lesion to be removed. The endoscopist should tattoo the lesion in order to allow the operating surgeon to then identify a mucosal lesion from the serosal side of the bowel, and thus remove the appropriate specimen.
♦ An abdominal computed tomography (CT) scan may also help localize the lesion to be removed as well as provide an anatomic overview of the patient’s abdomen.
♦ A full preoperative metastatic workup should be performed for malignant lesions.
♦ Patients should receive preoperative bowel preparation the day before surgery (e.g., GoLYTELY, HalfLytely, phospho soda, magnesium citrate).
♦ Within 1 hour of skin incision, intravenous (IV) antibiotics must be administered.
♦ Indications for laparoscopic right colectomy are the same as those for open colectomy and include colonic polyps, Crohn disease, colon cancer, and so on.
♦ Oncologic results have been shown to be equivalent between laparoscopic and open surgery for colon cancer.
♦ There are some contraindications to laparoscopic colectomy, which include the following:
Equipment and instrumentation
♦ Veress needle, 12-mm port, 5-mm ports.
♦ A 5-mm or 10-mm, 30-degree camera (a zero-degree camera can also be used).
♦ 5-mm LigaSure device (Covidien, Mansfield, Massachusetts) or Harmonic scalpel (Ethicon, Somerville, New Jersey).
♦ Endo GIA (Autosuture, Covidien) roticulating stapler with gastrointestinal (3.5-mm staple height) cartridge load for division of colon; a cartridge (2.5-mm staple height) for division of ileum and a vascular cartridge (2-mm staple height) can be used for division of ileocolic vascular pedicle instead of using one of the cutting or sealing devices LigaSure or Harmonic scalpel.
♦ An Endoloop (Ethicon, Somerville, New Jersey) should be available (although not necessarily opened) in case of the need for rapid vascular control.
♦ Laparoscopic suction/irrigator.
♦ Handheld linear cutting gastrointestinal stapler (3.5-mm staple height).
♦ Handheld linear non-cutting TA gastrointestinal stapler (3.5- to 4.8-mm staple height).
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