Full medial laparoscopic right colectomy for cancer of the ascending colon

This video shows a live right laparoscopic colectomy for the management of cancer of the ascending colon.

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Virtual University

Full   medial   laparoscopic   right   colectomy   for   cancer   of   the   ascending   colon

Authors
Abstract
This video shows a live right laparoscopic colectomy for the management of cancer of the ascending colon.
Classification
live recorded
Keywords
Media type
Duration
14'00''
Publication
2011-05
Popular
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Audio
en
Subtitles
en
E-publication
WeBSurg.com, May 2011;11(05).
URL: http://www.websurg.com/doi-vd01en3289.htm

Full   medial   laparoscopic   right   colectomy   for   cancer   of   the   ascending   colon

7. Anastomosis 06'59''
We can do an incision in front to do the anastomosis outside but we’ll do differently. We’ll maintain this. Now I have to find the ileum. How? I follow the limit of the section probably there. That’s it. We’ll fix together the 2 segments with a suture. I’m using the 5mm trocar, fixing together the 2 stumps on the antimesenteric side not too close (2cm), not too far. This is a landmark, as I said, to do a pulley. We will do an extracorporeal knot. On one side we will cut one thread. On the other side, both together. Because if we want to do the anastomosis outside, we will identify proximally and distally. We’ll introduce the anvil, like this. It’s an isoperistaltic anastomosis. We have to verify when we do the anastomosis that there is no twist particularly at the small bowel. We always carry out a bacterial examination at the end of the procedure when we have cleaned. We will do our main sutures now. First, I want to put the gauze in a plastic bag and I will push this inside. There is a valve, particularly interesting in the gallbladder because we have a valve inside trapping everything. So we lose nothing. If you want to use a lateral approach, well, it is not what I do or what it’s recommended to do. We do primary vascular approach in oncology. The advantage of monofilament, as you see, is to pass several stitches before pulling. I’m using Maxon 3/0. Now I pull the monofilament. It’s sliding. To prevent the suture from sliding, you do this: you twist and you have an eye friction. I will do now the second suture to finish medially. To make a knot, you stay close, you come around, you catch, and you have a flat knot. And the last one. We have to do a pulley to slide better. Now we will cut this. We have to close the mesenteric gap. We will remove the last suture later. We have two possibilities: using a lateral approach or a medial approach. It looks good to close like this. You can use running sutures or, as you will see, I use the titanium Endo-Hernia™ stapler. You can modify the angulation. You can rotate too, like this. And you can change the cartridge too. This a 10-staple cartridge. To change, you put like this and you push. And you have two sizes: a short size (blue cartridge) and a deep one (green cartridge). I would like to show the shape of the staples. When it’s close, it is like this. It\'s not new, it has existed for 20 years. It’s a 10mm device. You pre-fire. I’m not touching now. The staples are out so you can anchor this and you can complete like this.