Colorectal

Right Hemicolectomy (Laparoscopic) (Variant)

OPERATION: Right Hemicolectomy (Laparoscopic)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: IV antibiotics administered prior to skin incision
POSITION: Supine, both arms tucked at sides. Urinary catheter and nasogastric tube inserted. VTE prophylaxis applied.

INDICATION:
[Right-sided colonic carcinoma / caecal polyp not amenable to endoscopic resection / Crohn's disease / other]. Preoperative colonoscopy performed — tumour tattooed to facilitate intraoperative identification. CT staging: [findings]. Full metastatic workup performed.

PROCEDURE:
WHO Checklist performed. Abdomen prepared and draped.

PORT PLACEMENT:
Veress needle inserted in the left upper quadrant. Pneumoperitoneum established with CO2 to approximately 15 mmHg. 12 mm supraumbilical port inserted and 30 degree camera introduced. Abdomen inspected — no evidence of metastatic disease. Three 5 mm working ports inserted under direct vision: left lower quadrant, left upper quadrant, and subxiphoid.

DISSECTION:
Table positioned in Trendelenburg with left side down. Any adhesions divided using sharp dissection, abdomen explored for resectability. Appendix, caecum, and terminal ileum identified. Assistant provided medial traction on the caecum.

Right colon lateral attachments taken down. Right white line of Toldt incised sharply from the caecum, identifying and protecting the right ureter throughout. Dissection continued superiorly to and around the hepatic flexure with medial traction on the right colon. Patient placed in reverse Trendelenburg for hepatic flexure mobilisation. Duodenum (C-loop) identified and protected at all times. Right colon fully medialized.

DIVISION OF BOWEL AND VASCULAR PEDICLE:
Terminal ileum divided using the laparoscopic linear stapler. Mesentery divided using a 5 mm energy sealing device to maintain haemostasis while minimising thermal spread. Ileocolic vessels and right colic vessels divided proximally to encompass maximum lymph nodes [for malignant disease]. Distal resection margin on the transverse colon cleared and divided with the laparoscopic linear stapler.

SPECIMEN EXTRACTION AND ANASTOMOSIS:
Specimen placed in the right upper quadrant. Patient returned to neutral position. Umbilical or subxiphoid port site used for specimen extraction — port removed and site extended 4 cm vertically. Wound protector applied. Specimen delivered through the wound. Proximal ileum and distal transverse colon brought out extracorporeally.

Side-to-side functional end-to-end ileocolic anastomosis fashioned using a handheld linear GIA stapler. Common enterotomy closed with a TA stapler. Anastomosis inspected — patent and haemostatic. Bowel returned to abdomen.

Minilaparotomy wound closed in layers. Pneumoperitoneum re-established. Abdomen inspected for haemostasis. All ports removed under direct vision and closed.

FINDINGS:
[Tumour / polyp] at [location] — [size / macroscopic description]. [Tattoo identified at specimen]. Duodenum and right ureter protected. Adequate proximal and distal resection margins macroscopically. No visible metastatic disease.

SPECIMEN: Right hemicolectomy specimen to histopathology [orientated and inked].
EBL: [Volume] ml. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Enhanced recovery protocol. Nasogastric tube removed when appropriate. Oral fluids when tolerating. VTE prophylaxis continued. Outpatient review with histology.