Surgical approach to right colon cancer: From open technique to robot. State of art

Abstract

This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical, oncological and cosmetic advantages) even if all studies conclude that further prospective randomized trials are necessary. Robotic technique may be useful to overcome the problems related to inexperience in laparoscopy in some surgical centers.

Keywords: Extracorporeal anastomosis; Intracorporeal anastomosis; Mini-invasive right colectomy; Robotic right colectomy; Totally laparoscopic right colectomy.

Figure 1

Comparison between laparoscopic assisted right colectomy and totally laparoscopic right colectomy. From Fabozzi et al[32].

Figure 2

The right colon dissection. A: Ileo-colic artery and vein laparoscopic ligations; B: Ileo-colic mechanical anastomosis in totally laparoscopic right colectomy (TLC); C: Trocar sites and minilaparotomy site of TLC; D: Trocar sites and minilaparotomy site of laparoscopic assisted right colectomy (LAC); E: Right colon positioning in endobag during TLC; F: Mesentery laparoscopic suturing; G: Right colon removal by endobag in TLC.