**2. Surgical technique**

With the patient placed supine in neutral position, the surgeon and first assistants stand on left and the laparoscopic tower is situated on the right. Second assistant, if present, stand on the right. It is important that the patient is well secured to the operating table to avoid incidents during bed movement.

After surgical site disinfection, the pneumoperitoneum is established using open technique (our preferred method) or Veress needle. The first trocar is placed next to the navel. Once pneumoperitoneum has reached target pressure (12 mmHg), the exploratory laparoscopy is performed in order to assess the presence of carcinomatosis or metastases to solid organs missed by imaging on pre-operative staging, which may preclude tumor resectability. Two working trocar for surgeon are subsequently placed: one (10 mm) in the left upper quadrant and the other (10 mm) in the left lower quadrant. A fourth trocar (5 mm) can be positioned in right middle quadrant for further assistance (**Figure 1**).

Sliding and left shifting of the patient in Trendelenburg positioning (i.e. head lower than legs) facilitates optimal exposure of the operating field. This leads to a shift of greater omentum over the stomach and small bowel 'descent' towards the left upper quadrant allowing adequate exposure of cecum, ascending colon, right portion of mesocolon, ileocolic vessels and right colic vessels.

**107**

**Figure 3.**

*Dissection of colon from abdominal wall.*

*Laparoscopic Right Colectomy. Intracorporeal Anastomosis Is Associated with Better Outcome*

Using laparoscopic forceps, the assistant lifts up the ascending colon to expose the right portion of mesocolon that is straightened by the surgeon: this step allows

In case of malignant disease, it is mandatory to performed lymphadenectomy simultaneously with the resection of vascular stem. In order to do that, ileocolic and

Once vascular stem has been sectioned, visceral peritoneum is cut on ileocolic vessels axis in front of duodenum, so the colic dissection can be performed under a "tent" formed by Toldt's fascia and prerenal fascia from medial-to-lateral. The dissection must be continued up to cecum in distal direction and up to hepatic flexure in cranial direction paying attention to avoid to open retroperitoneum and

This procedure is continued until the horizontal part of the duodenum comes into view. The hepatocolic ligament is sectioned to allow separation of the ascending colon from the duodenum. Access into the omental bursa is facilitated by gentle caudal retraction of the transverse colon and incision of the gastrocolic ligament. Partial removal of the mesotranverse colon is performed towards the right

In this way the colon limb can be eviscerated or approached in a tension-free manner. At this point, using laparoscopic stapler, colon and ileum are sectioned

Until this moment, surgical procedure is the same for both totally intracorporeal and extracorporeal (i.e. with bowel transection and anastomosis performed out of

*DOI: http://dx.doi.org/10.5772/intechopen.93996*

visualization of ileocolic vessels (**Figure 2**).

to damage genital vessels or ureter (**Figure 3**).

(**Figure 4**) and the specimen is extracted using endobag.

colonic angle.

abdomen).

**Figure 2.** *A-artery, V-vein.*

right colic vessels must be ligated and sectioned at their origin.

**Figure 1.** *Trocars position.*

*Laparoscopic Right Colectomy. Intracorporeal Anastomosis Is Associated with Better Outcome DOI: http://dx.doi.org/10.5772/intechopen.93996*

Using laparoscopic forceps, the assistant lifts up the ascending colon to expose the right portion of mesocolon that is straightened by the surgeon: this step allows visualization of ileocolic vessels (**Figure 2**).

In case of malignant disease, it is mandatory to performed lymphadenectomy simultaneously with the resection of vascular stem. In order to do that, ileocolic and right colic vessels must be ligated and sectioned at their origin.

Once vascular stem has been sectioned, visceral peritoneum is cut on ileocolic vessels axis in front of duodenum, so the colic dissection can be performed under a "tent" formed by Toldt's fascia and prerenal fascia from medial-to-lateral. The dissection must be continued up to cecum in distal direction and up to hepatic flexure in cranial direction paying attention to avoid to open retroperitoneum and to damage genital vessels or ureter (**Figure 3**).

This procedure is continued until the horizontal part of the duodenum comes into view. The hepatocolic ligament is sectioned to allow separation of the ascending colon from the duodenum. Access into the omental bursa is facilitated by gentle caudal retraction of the transverse colon and incision of the gastrocolic ligament. Partial removal of the mesotranverse colon is performed towards the right colonic angle.

In this way the colon limb can be eviscerated or approached in a tension-free manner. At this point, using laparoscopic stapler, colon and ileum are sectioned (**Figure 4**) and the specimen is extracted using endobag.

Until this moment, surgical procedure is the same for both totally intracorporeal and extracorporeal (i.e. with bowel transection and anastomosis performed out of abdomen).

**Figure 2.** *A-artery, V-vein.*

*Colorectal Cancer*

surgical safety.

**2. Surgical technique**

trials showed comparable outcomes between open and laparoscopic surgery in

From a technical point of view, various operative factors - such as extent of resection, number of lymph nodes sampled, length of bowel and mesentery resected, and bowel margins – do not differ significantly between patients who underwent laparoscopic surgery and those who underwent open colectomy. With regards to intra-abdominal staging accuracy, laparoscopy allied with solid-organ

Laparoscopic right hemicolectomy is currently considered the standard of care

This chapter describes the technique for laparoscopic right colectomy technique, with a focus on ileo-colic anastomosis, highlighting the differences between intracorporeal and extracorporeal anastomosis fashions in terms of clinical outcome and

With the patient placed supine in neutral position, the surgeon and first assistants stand on left and the laparoscopic tower is situated on the right. Second assistant, if present, stand on the right. It is important that the patient is well secured to the

After surgical site disinfection, the pneumoperitoneum is established using open technique (our preferred method) or Veress needle. The first trocar is placed next to the navel. Once pneumoperitoneum has reached target pressure (12 mmHg), the exploratory laparoscopy is performed in order to assess the presence of carcinomatosis or metastases to solid organs missed by imaging on pre-operative staging, which may preclude tumor resectability. Two working trocar for surgeon are

subsequently placed: one (10 mm) in the left upper quadrant and the other (10 mm) in the left lower quadrant. A fourth trocar (5 mm) can be positioned in right middle

Sliding and left shifting of the patient in Trendelenburg positioning (i.e. head lower than legs) facilitates optimal exposure of the operating field. This leads to a shift of greater omentum over the stomach and small bowel 'descent' towards the left upper quadrant allowing adequate exposure of cecum, ascending colon, right

terms of overall survival and disease-free survival [3].

imaging offers adequate staging information [4].

in benign and malignant right colon disease [2].

operating table to avoid incidents during bed movement.

portion of mesocolon, ileocolic vessels and right colic vessels.

quadrant for further assistance (**Figure 1**).

**106**

**Figure 1.** *Trocars position.*

**Figure 3.** *Dissection of colon from abdominal wall.*
