Standardized hand-assisted laparoscopic right colectomy

INTRODUCTION Laparoscopic colectomy setup is sometimes a complex and dauntingtask. METHODS A standardized operating room setup for laparoscopic colon resection shows a simplified diagram of the location of equipment and team members relative to the patient. The minimum equipment required for successful surgery can be quickly organized. Another sheet outlines the steps taken during the resection. This patient had a right colectomy for a large colon polyp performed with a hand-assisted laparoscopic approach, with one monitor, using only electrocautery for dissection and Ligasure (TM) (Valleylab, Boulder, CO) to divide mesenteric vessels. Vascular staplers, Harmonic scalpel T (Ethicon, Cincinnati, OH), and clips were not necessary. A medial to lateral dissection was performed. The mobilized right colon was exteriorized through the handport. Resection and anastomosis were performed in one maneuver with a single GIA (TM) stapler (United States Surgical Corp., Norwalk, CT) with one refill. RESULTS The surgery took less than two hours. Final pathology showed a tubulovillous adenoma. There were no complications. The length of stay was three days. CONCLUSIONS Hand-assisted laparoscopic colectomy gives the surgeon confidence during dissection and transection of major vessels. Laparoscopic colon resection is faster with the hand-assisted approach. With a simplified setup, less time is wasted. This decreases cost of laparoscopic colectomy.