Laparoscopic Right Hemicolectomy

The patient is a [age]-year-old [male/female] with [indication] presenting for elective laparoscopic right hemicolectomy. The risks, benefits, and alternatives were discussed with the patient, and informed consent was obtained.

A [tumor/mass/polyp] was identified in the [cecum/ascending colon/hepatic flexure] measuring approximately [___] cm. The bowel was otherwise [normal / with skip lesions noted]. The mesentery was [uninvolved / with enlarged lymph nodes]. The liver, peritoneum, and remaining abdomen were [without evidence of metastatic disease / with ___ lesions noted]. [Additional findings or none].

The patient was brought to the operating room and placed supine in modified lithotomy position. General endotracheal anesthesia was induced without difficulty. A Foley catheter was placed. A surgical timeout was performed confirming patient identity, procedure, operative site, allergies, and administration of prophylactic antibiotics.

The abdomen was prepped and draped in sterile fashion. A periumbilical incision was made and pneumoperitoneum was established to 15 mmHg with a Veress needle. A 12-mm umbilical trocar was placed. Three additional trocars were placed under laparoscopic guidance: a 12-mm left lower quadrant port, a 5-mm left upper quadrant port, and a 5-mm suprapubic port. The patient was positioned in Trendelenburg with left lateral tilt to displace the small bowel out of the operative field.

Abdominal exploration was performed and the findings confirmed. Using a medial-to-lateral approach, the ileocolic pedicle was identified by lifting the right mesocolon off the retroperitoneum. The ileocolic artery and vein were dissected, individually ligated with [hem-o-lok clips / stapler], and divided at their origins, achieving a high ligation. The right branch of the middle colic artery [and vein] was similarly ligated and divided.

The retroperitoneal dissection was continued along the Toldt fascia plane, sweeping the right mesocolon off Gerota's fascia and the duodenum. The right ureter and gonadal vessels were identified and swept posterolaterally. The hepatocolic ligament and remaining peritoneal attachments were divided. The terminal ileum, cecum, ascending colon, and hepatic flexure were fully mobilized.

A periumbilical extraction incision was made and extended to [___] cm. A wound protector was placed. The mobilized right colon was delivered through the extraction site. The terminal ileum was divided approximately 10 cm from the ileocecal valve with a [GIA stapler]. The transverse colon was divided at the hepatic flexure/proximal transverse colon with a [GIA stapler]. The specimen was removed and passed off the field.

A side-to-side [functional end-to-end] ileocolonic anastomosis was fashioned extracorporeally using a [GIA 75 or 80 mm stapler] inserted into enterotomies on the antimesenteric borders of the ileum and colon. The enterotomy was closed with [TA stapler / hand-sewn two-layer technique]. The anastomosis was inspected and confirmed to be widely patent without tension, bleeding, or leak. The mesenteric defect was closed with [interrupted 2-0 silk sutures].

The bowel was returned to the abdominal cavity. The extraction incision fascia was closed with [0-PDS] running suture. The peritoneal cavity was irrigated. Trocars were removed under direct visualization. The umbilical fascia was closed. Skin was closed with [4-0 Monocryl] subcuticular sutures. Sterile dressings were applied.