OR / Prep · Colorectal Surgery · laparoscopic
You’re scrubbing into
Right hemicolectomy
Why are we operating?
Resection of the right colon for cancer: take the vessels at their origin, take the nodes with them, and join ileum to transverse colon.
Indication: Right-sided colon cancer; caecal volvulus; some right-sided Crohn's complications.
Read the imaging first
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The operation in 4 steps
01Access and staging the abdomen
Ports placed, the liver and peritoneum inspected before any dissection commits the operation.
Why: The abdomen is staged with the camera first because unexpected metastatic disease can change the goal from cure to palliation before anything irreversible is done.
02Vascular pedicle first
The ileocolic pedicle is lifted, windows opened either side, and the vessels clipped and divided at their origin from the superior mesenteric vessels.
Why: Cancer surgery follows the lymphatics, and the lymphatics follow the arteries: a central vascular tie is what makes the specimen an oncological one rather than a piece of colon. The duodenum lies directly behind this pedicle and is identified before anything is divided.
03Mobilisation
The right colon is freed medial-to-lateral off the retroperitoneum, then the hepatic flexure taken down.
Why: The embryological plane between mesocolon and retroperitoneum is avascular and keeps the dissection safely in front of the structures that must stay: duodenum, ureter, gonadal vessels.
04Resection and ileocolic anastomosis
Terminal ileum and colon divided at healthy margins and an ileocolic anastomosis fashioned, commonly stapled side-to-side.
Why: The join needs the same three things every anastomosis needs: blood supply, no tension, and healthy ends. The ileocolic join is the most forgiving in the colon, which is why this is often a trainee's first cancer resection.
Anatomy you need
Cecum to mid-transverse colon and the terminal ileum that joins the anastomosis; the ileocolic pedicle is the operation.
What can go wrong
Anastomotic leak
Day 3–7: tachycardia, fever, abdominal pain, ileus that fails to resolve, or subtle deterioration that 'doesn't add up'.
Postoperative bleeding
Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.
Postoperative ileus
Distension, absent flatus, intolerance of diet, and quiet bowel sounds in the days after abdominal surgery.
Surgical-site infection
Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.
Watch it done
Right hemicolectomy explained
The operation drawn and narrated by surgeons who teach it: mobilisation, vessels, anastomosis.
Source: School of Surgery · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.