ROBOTIC RIGHT HEMICOLECTOMY WITH COMPLETE MESOCOLIC EXCISION-Dr.Jagdishwar Goud Gajagowni,Apollo Hospitals, Hyderabad,INDIA

GOAL OF THE SURGERY

1. Complete clearance of Colon with LN clearance including central nodes
2. Colon with meso colic fascia
3. Ligation of Ileo Colic vessels at the origin

POSITION

1. Supine with 15 degrees head up and 10 degrees right up

PORTS

1. Camera to the left and below umbilicus on a line from mid clavicular point to pubic symphysis
2. Bipolar port 2 finger breadths above symphysis 
3. Mono polar hand breadth from the camera port on the same line
4. Pro grasp or Cardiere hand breadth away from Bipolar port
5. Assistant port 10 mm or 5 mm in between 2 and 3

STEPS

1. Incision of Right colon mesentery approximately in the line of SMV and dissect medio laterally
2. Clear tissue over SMV and SMA and identify IC vessels
3. Clear the central nodes and carefully clip and transect ICA and ICV
4. Look from the plane of mesocolon and retroperitoneal tissue and dissect over Pancreas and Duodenum as much laterally as possible
5. Use 4^th arm and roll over Transverse Colon up , identify Middle Colic vessels, Right branch of MC vessels, BE VERY CAREFUL and clip them very carefully. The gastroepiploic vein from Gastro Colin Vein is the most delicate step and be very cautious.
6. The Ileal mesentery secured send transected
7. The Transverse Colon mesocolon secured and transected
8. Use ICG for vascularity
9. Start Lateral dissection, keep away from the Colon Wall, mobiles from right lateral Transvers colon and down to right colon to caecum and segment if Ileum
10. Anastomosis-Staple Ileum, Transverse Colon separately , and bring them together to do side to side Ileo Transvers anastomosis or Bring both  transected Ileum to transverse colon, put a stay stitch, give a nick to insert staplers and do side to side anastomosis, Transect with staplers across the rent at the tip os anastomosis and free the anastomosed area. And suture the stapler insertion site.