Right Colectomy (Open, Laparoscopic, Robotic)

Procedure Snapshot

• Indication: Cecal/ascending colon malignancy, Crohn disease, trauma.
• Expected duration: ___
• Special instruments: Staplers, lap ports, energy device.

Step Workflow — Open

1. Midline incision; mobilize right colon lateral → medial (divide white line of Toldt).
2. Identify ureter & duodenum (preserve).
3. Ligate ileocolic, right colic vessels.
4. Divide terminal ileum & transverse colon; perform anastomosis.

Step Workflow — Laparoscopic/Robotic

1. Ports: umbilical, LLQ, suprapubic.
2. Medial-to-lateral approach identifying SMA/SMV.
3. Skeletonize vessels, divide ileocolic.
4. Extracorporeal stapled anastomosis.

Key Pimp Questions

• Q: Blood supply? Ileocolic, right colic, middle colic branches of SMA.
• Q: Duodenum injury prevention? Stay anterior to Gerota’s fascia.
• Q: Lymph node harvest goal? ≥ 12 (PMID 30928102).

Critical Anatomy

• Landmarks: SMA/SMV, duodenum (2nd portion), ureter.
• Danger zones: SMV tears, retroperitoneum.

Informed Consent Highlights

• Leak, bleeding, ileus, anastomotic failure.

Post-op Considerations

• ERAS mobilization; clear liquids POD 1.

References

• Chassin’s, Colon chapter; Clinical Scenarios, GI.
• Deguara 2020 (PMID 30928102).