From the Research
A robotic right hemicolectomy involves several key steps, including patient positioning, port placement, robotic docking, and a systematic approach to dissecting and removing the affected colon segment, as described in the most recent and highest quality study 1. The procedure typically begins with the patient in a modified lithotomy position, followed by the establishment of pneumoperitoneum and the placement of ports for the robotic arms and assistant instruments. The robot is then docked, and the procedure commences with exploration of the abdominal cavity, identification of key anatomical structures, and meticulous dissection to ensure complete removal of the diseased segment while preserving vital structures. Key steps include:
- Identification and division of the ileocolic vessels
- Mobilization of the right colon by dividing lateral peritoneal attachments and the hepatocolic ligament
- Division of the mesentery along the planned resection line
- Transection of the bowel at the terminal ileum and transverse colon
- Creation of an ileocolic anastomosis, which can be performed intracorporeally or extracorporeally
- Closure of the mesenteric defect and removal of the specimen
- Final checks for hemostasis and closure of port sites This approach, as outlined in recent studies 2, 3, 1, offers enhanced visualization, improved dexterity, and potentially faster recovery times compared to traditional open surgery, while maintaining adherence to oncologic principles for cancer cases. The choice of approach, whether lateral to medial or medial to lateral dissection, may depend on the surgeon's preference and the specific anatomy of the patient, as both methods have been shown to be effective in telerobotic-assisted laparoscopic right hemicolectomy 4. However, the most recent study 1 highlights the safety and feasibility of a suprapubic single-port robotic right hemicolectomy, which may offer additional benefits in terms of reduced port sites and potentially less postoperative pain. Overall, the goal of robotic right hemicolectomy is to provide a minimally invasive, effective, and safe treatment option for patients with right colon cancer or other conditions requiring removal of the right colon, with a focus on optimizing outcomes in terms of morbidity, mortality, and quality of life.