Laparoscopic Extended Right Hemicolectomy - Carcinoma of the Cecum

Surgical video case: 72 year old female patient, laparoscopic right hemicolectomy for adenocarcinoma of the cecum.

Laparoscopy has emerged as the preferred operative approach for most intra-abdominal pathologic conditions. Nonetheless, even though the first laparoscopic colectomy was reported decades ago, the majority of colectomies are still being performed via the open approach. This delay in acceptance has mainly been attributable to initial concerns regarding the adequacy of oncologic margins and trocar site recurrences believed to occur with laparoscopy. The goals of laparoscopic right hemicolectomy (right colectomy) performed in the setting of colon cancer are the same as those of the equivalent open procedure. They involve appropriate vessel ligation, creation of sufficient luminal margins, and adequate lymph node sampling. In addition, a thorough inspection of the abdominal cavity and liver surface is expected, together with the creation of a reliable anastomosis. Laparoscopic colectomy for resectable colon cancer has been reported to be technically and oncologically feasible. The general consensus, based on the literature over the past several years, is that there is no significant difference in lymph node harvest between laparoscopic and open right hemicolectomies for cancer when strict oncologic principles of resection are followed. To date, patient survival, disease progression, and cancer recurrence at port sites have been found to be equivalent between laparoscopic colectomy and traditional open colectomy.