Surgery setup images for Laparoscopic Hemicolectomy
Mayo stand and back table instruments for Laparoscopic Hemicolectomy surgery setup
Clamping & Occluding
Cutting & Dissecting
Grasping & Holding
Dissecting Laparoscopic Grasper Forceps
Laparoscopic Bowel Grasper
Laparoscopic DeBakey Forceps
Laparoscopic Hunter Bowel Grasper
Retracting & Exposing
Suturing & Stapling
What to expect during Laparoscopic Hemicolectomy
Laparoscopic hemicolectomy is a surgical procedure used to treat colon cancer or other conditions affecting the colon. During the procedure, a portion of the colon is removed, and the remaining healthy parts of the colon are reconnected to restore the normal digestive function. The surgery is performed through small incisions using a laparoscope, a special camera that allows the surgeon to see inside the abdomen, and specialized instruments. Laparoscopic hemicolectomy is a minimally invasive surgery that offers several benefits over traditional open surgery, including less pain, faster recovery, and a shorter hospital stay.
Folded towels, laparotomy drape
Step 1: Making the Incision and Entering the Abdominal Cavity
The first step in a laparoscopic hemicolectomy is to make the incision with either an 11 blade or a 15 blade on a #3 knife handle inferior to the umbilicus. After the initial incision, a Kocher clamp is used to elevate the tissue, and the blade is used again to finish the incision. A UR-6 suture is commonly used on both sides of the incision and clamped with hemostats on the end. The Metz will be used to enter the abdominal cavity, and a 12 mm Hassan is inserted into this incision. Insufflation can then be turned on.
Step 2: Inserting the Scope and Trocars
After the scope has been white balanced, it can be inserted through the trocar for visualization. Usually, around three smaller trocars are placed. The patient will then be put into Trendelenburg with their right side up.
Step 3: Using Instruments to Take Down Attachments and Adhesions
A Harmonic is commonly used for taking down attachments and adhesions. Different doctors prefer different laparoscopic graspers, but commonly used ones are DeBakeys and bowel graspers. These instruments will be used for a large portion of the surgery, taking structures down, and moving them around. The PA, resident, you, or some sort of second person will need to retract using one of the graspers.
Step 4: Clipping Vessels and Cutting with Harmonic or Scissors
Either a reusable or disposable clip applier will be used to clip vessels. Either the Harmonic or scissors will be used to cut them. Sometimes a Ligasure is used.
Step 5: Delivering the Specimen and Creating the Anastomosis
The umbilical incision will be made bigger using a 15 blade, and an Army Navy retractor can be used to retract. Once the incision has been made to the appropriate size, a wound protector (Alexis) will be placed. The specimen/tumor will be delivered through the Alexis, and a GIA stapler will be used to staple and cut the portion of colon off. The specimen should be considered contaminated since it is colon, so it and the stapler should be placed in a separate area so the rest of your things aren’t contaminated.
A Babcock clamp is placed on the distal side, and the distal ileum will be delivered through the Alexis. The two ends of the bowel are placed together for the anastomosis, and a 75 GIA is commonly used to create the anastomosis. The bovie will be used to create a hole where the stapler can be placed into, and it will be widened with a hemostat or tonsil. An Allis clamp may also be used to help with the stapler placement. The stapler will be fired, and hemostasis is confirmed. Several Allis clamps will be used to help close the rest of the defect with the commonly used TA 60 stapler.
Step 6: Closing Incisions and Checking for Bleeding
The bowel can be dropped back into the abdomen, and that incision can be closed. The abdomen will be reinsufflated, and the abdominal cavity will be checked for any bleeding, as well as be irrigated and suctioned. The trocars can be removed, and all incision can be closed. 4-0 monocryl is commonly used.
The Surgery Sparknotes
- Make an incision with an 11 or 15 blade and elevate tissue with Kocher clamp. Use Metz to enter the abdominal cavity.
- Insert scope through trocar for visualization. Place 3 smaller trocars.
- Use Harmonic to take down attachments and adhesions. Use DeBakeys or bowel graspers to move structures.
- Clip vessels using a clip applier or cut with Harmonic or scissors.
- Make umbilical incision bigger with 15 blade, place Alexis wound protector, and remove specimen with GIA stapler.
- Deliver distal ileum through Alexis and use 75 GIA stapler to create anastomosis.
- Use TA 60 stapler and Allis clamps to close defect. Check for bleeding, irrigate, and suction.
- Remove trocars and close incisions using 4-0 monocryl.