Author/Editor		Baca, Ivo; Vračko, Jože; Soldo, Ivo; Kondža, Goran; Perko, Zdravko
Title		Laparoscopic technique for right hemicolectomy
Translated title		Laparoskopska desna hemikolektomija
Type		članek
Source		Endoskopska Revija
Vol. and No.		Letnik 12, št. 27
Publication year		2007
Volume		str. 31-5
Language		eng
Abstract		Removal of both benign and malignant lesions of the distal ileum, cecum, ascending colon and hepatic flexures can be managed by right colectomy. This article focuses upon the technical issues of laparoscopic right colonic resection, which involves complete mobilization of the terminal ileum and right colon to the level of midportion of the transverse colon. Patient preparation for laparoscopic right colectomy is identical to that used for the open procedure and the patient is placed in a normal or lithotomy position. Insertion of three of the four trocars used depends on the patient’s body habitus, type of resection and operative findings. Vascular isolation done through the windows in the mesocolon is recommended before colon mobilization. A harmonic scalpel is used for ileocolic mobilization to provide improved haemostasis. Retraction is facilitated by using the companion port, thereby allowing the surgeon to use a two-handed technique. After the entire colon has been mobilized, vascular ligation and anastomis are made extacorporeally for the laparoscopic-assisted technique. Extension of the umbilical incision and entrance into the peritoneal cavity is facilitated by incising along the shaft of the trocar. Application of a small drape for wound protection is manadatory before withdrawing the port, grasper and cecum as one unit. The rest of the specimen is removed, and there follows safe and rapid division of the vascular supply and bowel anastomosis outside the peritoneal cavity. Currently, the laparoscopic-assisted method is favoured over the total intracorporeal approach because the latter is more technically demanding and time-consuming, less cost-effective and less safe, and carries an increased risk of contamination.
Summary		Z desno hemikolektomijo lahko odstranimo benigne in maligne spremembe distalnega ileuma, cekuma, ascendentnega kolona in hepatične fleksure. V prispevku je prikazana tehnična izvedbanlaparoskopske resekcije desnega kolona z mobilizacijo terminalnega ileuma in desnega kolona do sredine prečnega kolona. Priprava bolnika za laparoskopsko desno hemikolektomijo je enaka kot za odprto operacijo. Bolnik je na operacijski mizi v normalnem ali litotomijskem položaju. Tri do štiri troakarje uvedemo na mestih, ki so odvisna od bolnikove konstitucije, vrste resekcije in najdbe pri operaciji. Pred mobilizacijo kolona je priporočljivo izolirati žile preko okna, narejenega v mezokolon. Uporaba harmoničnega skalpela pri ileokolični mobilizaciji pripomore k izboljšani hemostazi. Retrakcijo olajšamo z uporabo dodatnega troakarja, tako da kirurg lahko uporablja obe roki. Ko je kolon mobiliziran, se pri laparoskopsko asistirani operaciji žile ligirajo in pa se naredi anastomoza zunajtelesno. Povečanje incizije umbilikalno in vstop v peritonealno votlino je olajšan z rezom ob troakarju. Preden hkratni izvlečemo troakar, prijemalke in cekum je treba zaščititi operativno rano. Nato odstranimo še ostali del preparata, prekinemo žilno preskrbo in naredimo anastomozo zunaj peritonealne votline. Laparoskopsko asistirana metoda ima prednost pred popolnim znotrajtelesnim posegom, ker je ta poseg tehnično zahtevnejši, traja dalj časa, je dražji, manj varen, poveča pa se tudi možnost okužbe.
Descriptors		COLECTOMY LAPAROSCOPY