Laparoscopic Right Hemicolectomy and Sigmoidectomy with Transvaginal Specimen Extraction

Abstract

At present, with the increasing incidence of colorectal cancer, the incidence and diagnosis rates of multiple primary colorectal cancer (MPCRC) are also increasing. Patients with right colon cancer complicated with sigmoid colon cancer need to receive radical resection for both right colon cancer and sigmoid colon cancer, which involve many organs. In addition, since the right colon has many adjacent organs, complicated vasculature, and high incidence of anatomical variations, this procedure is a very difficult technique in NOSES. When NOSES is performed in the right colon alone, the vagina is the preferred route of specimen extraction. When the patient is complicated with cancer in other parts of the colon, the specimen can be extracted along with the right colon specimen through the vagina. The main operating features of right colon cancer resection include complete dissection and transection of the right hemicolon in the abdominal cavity, totally laparoscopic functional end-to-end anastomosis between the terminal ileum and transverse colon, and transvaginal specimen extraction. The specimen extraction methods for sigmoid colon resection vary based on the different tumor sizes, but the principles of CME should be strictly followed. Anatomy and dissection should be performed at the correct operating plane, which is a prerequisite for the rapid and safe operation. The operating difficulties of this procedure mainly involve three aspects. Firstly, the laparoscopic technical difficulties include the correct identification of anatomical landmarks, reasonable surgical approach and complete mesentery resection, ligation of vessels at the root of the mesentery and dissection of lymph nodes, and the exposure and protection of important tissues and organs. Secondly, the technical difficulty of NOSES in the right colon cancer and sigmoid colon cancer is totally laparoscopic digestive tract reconstruction for twice, which is more difficult than other procedures. Thirdly, this procedure requires surgeons and assistants to have better cooperation. In the process of specimen extraction, the precise application of aseptic and tumor-free techniques is crucial.