Three-Port Laparoscopic Complete Mesocolic Excision and Intracorporeal Anastomosis for Right-Sided Colon Cancer

Complete mesocolic excision (CME) for colon cancer produces favorable oncologic outcomes.1 Recently, intracorporeal anastomosis (IA) has been demonstrated to result in less pain, fewer complications, and earlier recovery compared with extracorporeal anastomosis in laparoscopic right hemicolectomy (LRH).2,3 To minimize the incisional trauma, a reduced-port technique has been applied successfully in LRH.4,5 Here, we present a video of 3-port LRH with CME and IA for right-sided colon cancer.The results of a colonoscopy in a 58-year-old man revealed a mass in the ascending colon. A biopsy confirmed an adenocarcinoma. Preoperative abdominal CT scan confirmed that the colon lesion was without enlarged mesenteric lymph nodes. A 4 cm transverse mini-incision was made 4cm below the umbilicus for specimen extraction in which a glove port was used for the laparoscope. Two additional working ports were inserted in the left lower quadrant of the abdomen. Mobilization of the right colon from the cecum to the hepatic flexure using a caudal-to-cranial approach was performed along the Toldt space. After adequate mobilization of the ascending colon, the right colic vessels were dissected with D3 lymphadenectomy and ligated at their origin. The gastrocolic ligament was divided, and the right hemicolon was fully mobilized. The terminal ileum was transected 15 cm proximal to Bauhin’s valve using a linear stapler. We then transected the transverse colon 10 cm distal to the tumor. A side-to-side ileotransversostomy in an isoperistaltic manner was performed using a 60-mm linear stapler after enterotomy. Subsequently, the enterotomy was closed in a single layer with 3-0 V-Loc suture. The total procedure time was 200 minutes. The postoperative course was uneventful, and the patient was discharged on the sixth postoperative day.In conclusion, 3-port LRH with CME and IA appears to be feasible and safe in selected patients with right-sided colon cancer. See Video at http://links.lww.com/DCR/C32. Copyright © 2022 American Academy of Neurology.