Laparoscopic-assisted single-port right colectomy: a standardized top-down technique and tricks to perform a better anastomosis

Colorectal cancer has become the third most commonly diagnosed cancer, posing a significant public health concern. Advances in surgery, including laparoscopic and robotic techniques, have improved treatment options. A major development in treating right colon cancer is complete mesocolic excision (CME) with central vascular ligation (CVL), introduced by Hohenberger et al. in 2009. This method focuses on precise dissection to preserve the visceral fascia and reduce tumor spread, including regional lymph node dissection and central ligation of colonic arteries. Laparoscopic colectomy with intracorporeal anastomosis has also gained popularity due to improved techniques. The laparoscopic single-port right colectomy starts with the surgeon between the patient’s legs, using a single-port access device inserted through a suprapubic incision. The gastrocolic ligament is divided towards the hepatic flexure, allowing visualization of the duodenum. Traction exposes the ileocolic vessels, which are dissected and divided. The right colic vessels are also isolated if present. The last ileal loop is isolated, the mesentery divided, and the bowel transected with a linear stapler. The transverse colon is divided, and an intracorporeal latero-lateral ileo-colic anastomosis is performed using a barbed suture to prophylactically close the posterior corner and facilitate stapler introduction. After anastomosis, the posterior corner and enterotomy are closed with the running suture. The procedure concludes with specimen extraction through the suprapubic incision.