Single-incision laparoscopic right hemicolectomy: inferior-to-superior approach with intracorporeal anastomosis.
BACKGROUND
Single-incision laparoscopic right hemicolectomy has been shown to be safe and feasible; however, it remains technically demanding. We present a single-incision laparoscopic right hemicolectomy with an inferior-to-superior approach with intracorporeal anastomosis. This approach may help overcome some of the technical challenges of the conventional technique.


METHODS
With the patient in steep Trendelenburg and right-side elevated, a single-incision device is placed at the umbilicus. The small bowel is mobilized out of the pelvis, exposing the ileocolic peritoneal attachments. The peritoneum is divided and the retroperitoneal plane is established in a cranial and medial fashion until the duodenum is exposed. The ileocolic pedicle is readily identified and divided. Further exposure of the retroperitoneal plane is developed and the right branch of the middle colic vessel is isolated and divided. Attention is drawn to the remaining attachments of the hepatic flexure, which is then taken down. The resection margins of the transverse colon and terminal ileum are identified and a side-to-side intracorporeal anastomosis using a double-stapled technique is performed.


CONCLUSIONS
Technical challenges of the single-incision laparoscopic right hemicolectomy may be overcome utilizing an inferior-to-superior approach with intracorporeal anastomosis by affording optimal exposure, retraction, and dissection of the tissue planes.
*Department of Surgery, Division of Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston †Colorectal Surgical Associates LLP Ltd, Houston, TX.
Eric M
EM
Haas
Rodrigo
R
Pedraza
Javier
J
Nieto
Victor
V
Malave
D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery; D004210:Dissection / Q000379:methods; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D016896:Treatment Outcome