Robotic Right Colectomy with Complete Mesocolic Excision and Intracorporeal Anastomosis: Bottom-To-Up Suprapubic Approach

Giampaolo Formisano, MD; Sofia Esposito, MD; Giuseppe Giuliani, MD; Adelona Salaj, MD; Lucia Salvischiani, MD; Paolo P. Bianchi, MD

Product Details
Product ID: ACS-5970
Year Produced: 2019
Length: 8 min.


We describe a bottom-to-up approach for robotic right colectomy with Complete Mesocolic Excision, Central Vascular Ligation and intracorporeal anastomosis using the Da Vinci® Xi Surgical System. The patient is an 82 years old man with adenocarcinoma of distal ascending colon. The patient is supine with a slight Trendelemburg and left tilt (5-10°). Three 8-mm and one 12-mm robotic trocars are placed along a horizontal line, about 2-3 cm above the pubis. A 12-mm assistant port is inserted in the left flank. The mesenteric root is detached with a bottom-to-up approach from the Gerota's fascia till the duodenum is exposed, preserving the integrity of the posterior mesocolic layer. The visceral peritoneum is incised along the axis of superior mesenteric vessels. Ileocolic vessels are ligated together at their origin. Lymph node dissection is carried out in a caudal-to-cranial manner along the anterior aspect of the SMV. Careful dissection is continued until Henle's trunk is exposed. Right colic artery is dissected. Superior right colic vein and right branch of middle colic artery are divided at their roots. An intracorporeal robotic stapled ileocolic anastomosis is performed. A mini-suprapubic incision (resulting from the connection of the two paramedian suprapubic trocar sites) is used for specimen extraction.Operative time was 170 minutes. The patient was discharged on postoperative day 4 with no complications. Pathology reported adenocarcinoma G2(pT2N0, 31 harvested nodes). This approach provides a good frontal visualization of the superior mesenteric axis allowing for a safe central vascular ligation and exposure around the Henle trunk.