Live surgeryMay 25, 20262:43:562 speakersAvailable in: EN / IT
ICG-guided laparoscopic right hemicolectomy
Live surgery of laparoscopic right hemicolectomy with indocyanine green, narrated step-by-step by Gian Luca Baiocchi for an audience of operating-room nurses.
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Clinical case
Voluminoso adenocarcinoma stenosante del colon destro (ascendente/cieco)
Patient framing as discussed at case introduction
SexF
Age70 anni
StageSospetto T4 all'esame estemporaneo del pezzo, con linfonodo metastatico lungo i vasi colici di destra
DiagnosisVoluminoso adenocarcinoma stenosante del colon destro (ascendente/cieco)
Prior treatmentNessuno
Clinical historyPaziente con varicocele pelvico (vene uterine dilatate), addome con colon disteso e ricco di materiale fecale; non pregresse appendicectomie né interventi addominali maggiori.
NotesICG iniettato per via sottosierosa a monte e a valle del tumore; ICG endovenoso somministrato dal ferrista per angiografia di perfusione dei monconi anastomotici. Anastomosi ileo-colica intracorporea meccanica (carica viola 60 mm) con enterotomia chiusa in V-Loc a doppio strato.
Overview
A live teaching session by Gian Luca Baiocchi (Cremona Hospital) dedicated to operating-room nursing staff: during an ICG-guided laparoscopic right hemicolectomy for a bulky right-colon adenocarcinoma in a 70-year-old woman, the operator explains every technical, anatomical and instrumental aspect in real time. The didactic format is built for the people who experience surgery from the other side of the drape: induction of pneumoperitoneum with a Veress needle at Palmer's point, the optical trocar with retention balloon, warming the laparoscope to 70 °C, use of the Stryker fluorescence stack, the role of continuous insufflation/desufflation, and the choice of cartridges for the Signia mechanical stapler.
The core of the procedure is the subserosal injection of indocyanine green upstream and downstream of the tumor: Baiocchi shows how ICG migrates along the lymphatic vessels and illuminates the nodal pathway, revealing that this tumor drains primarily along the right colic vessels (and not along the ileocolic vessels), thereby justifying an extension of the lymphadenectomy in line with the principles of Complete Mesocolic Excision (CME), with dissection extending to the left of the superior mesenteric vein. The session covers the anatomical pitfalls of the embryological plane between the mesocolon and Toldt's fascia, the ureter crossing the iliac artery, recognition of the gastrocolic trunk of Henle, and the anatomical variability between a true right colic artery and the right branch of the middle colic artery.
The final part covers the intravenous ICG angiography performed by the scrub nurse to verify perfusion of the bowel stumps, the mechanical intracorporeal ileocolic anastomosis with a 60 mm stapler (purple cartridge), double-layer closure of the enterotomy with self-locking V-Loc suture, drain placement, and specimen extraction through an Alexis wound protector. Two questions from the nurses in the room are addressed along the way: residual nutritional function after removal of the ileocecal valve (and how to manage softer post-operative stools) and bowel preparation protocols (the Miracle protocol with peri-operative oral Augmentin). Ex-vivo examination of the specimen confirms a full-thickness lesion (suspected T4) with a metastatic node along the right colic vessels, clearly highlighted by ICG.
Topics
Laparoscopic setup and trocar placement in right hemicolectomy
Pneumoperitoneum induction with the Veress needle at Palmer's point
Optical trocar with retention balloon and laparoscope warming
Stryker stack for ICG fluorescence-guided surgery
Subserosal ICG injection upstream and downstream of the tumor
ICG-guided nodal navigation in the right colon
Complete Mesocolic Excision (CME): indications and technique
Anatomical variability between a true right colic artery and the right branch of the middle colic artery
Identification of the superior mesenteric vein and the gastrocolic trunk of Henle
Embryological plane between mesocolon and Toldt's fascia
Position of the ureter and its relationship to the iliac artery
Role of the ileocecal valve and nutritional consequences of right hemicolectomy
Mechanical vs oral antibiotic bowel preparation (Miracle protocol)
