完全机器人下右半结肠根治性切除术

Totally robotic right hemicolectomy with complete mesocolic excision

患者女,66岁,升结肠癌。右高左低平卧位。机器人置于右肩旁。3号臂牵拉回结肠皱襞,切开并拓展Toldt间隙。沿肠系膜上静脉分离,切断回结肠血管。显露结肠中动脉并在根部结扎其右支。本例Henle干由胃网膜右静脉、右结肠静脉(RCV)及副右结肠静脉(ARCV)汇合而成。结扎切断RCV与ARCV。在Gerota筋膜与Toldt筋膜间继续拓展平面完成游离。在回肠末段与横结肠中段用腔镜切割器横断。机器人下完成回肠横结肠侧侧吻合。

A 66-year-old female patient with ascending colon cancer. The robot is placed beside patient＇ s right shoulder. The procedure begins by grasping upward and laterally of the ileocolic mesentery. The Toldt＇s space is divided and expanded. An accurate lymphadenectomy is performed along the superior mesenteric vein （SMV）. The ICV are isolated and resected. It is easily to identify the constant middle colic artery （MCA） and to transect the right branch of MCA. In this case, the Henle trunk consisted of right gastroepiploic vein, accessory right colic vein （ARCV） and right colic vein （RCV）. After transection of the ARCV and RCV, mobilization of the colon is performed between Gerota＇ s and Toldt＇ s fascia. The transverse colon and the last ileal loop are sectioned by linear stapler. A side to side ileocolic anastomosis is performed under robotic system with Endo GIA staplers.