Robotic Right Colectomy with Complete Mesocolic Excision, Bottom-to-Up Approach and ICG Fluorescence-Guided D3 Lymphadenectomy

Wanda Petz, MD; Emilio Bertani, MD; Alessandra Piccioli, MD; Simona Borin, MD; Giuseppe Spinoglio, MD

Product Details
Product ID: ACS-5536
Year Produced: 2018
Length: 9 min.


We present the technique of robotic right colectomy with complete mesocolic excision (CME) and D3 lymphadenecomy using Indocyanine Green (ICG) fluorescence. Patient is a 60 year-old woman with a histology-proven adenocarcinoma of distal ascending colon. To achieve a lymphatic mapping, the day before surgery, a colonoscopy was performed and four injections of 1.5 ml of ICG solution were realized around the tumor in the submucosa. Robotic right hemicolectomy is performed with suprapubic trocars layout and bottom to up dissection, realizing a CME with central vessel ligation and a D3 lymphadenectomy. The root of terminal ileum is detached from posterior peritoneum, gaining access to the duodenum and to anterior aspect of the pancreas, over the superior mesenteric vessels. Then, the peritoneum of ileal mesentery is inceised at the left aspect of superior mesenteric vessels, reaching posteriorly the prior dissection plane, thus completing a lymphadecectomy of the anterior, right lateral and posterior aspect of superior mesenteric vessels. Ileocolic and right colic vessels are sectioned. Lymphadenectomy of midlle colic artery and section of its right branch are performed. Section of mesocolon and mesentery and of transverse colon and terminal ileum are realized. Right colon and right flexure are detached from posterior peritoneum. ICG is then intraoperatively administered intravenously (0.05 mg/kg of ICG solution at a dilution of 2.5 mg/ml) to objectively assess bowel perfusion before anastomosis. After a short time (approximately 30-60 seconds), perfusion of terminal ileum and colon is visually confirmed. A side-to-side mechanical isoperistaltic ileo-colic anastomiosi is finally performed.