Laparoscopic right hemicolectomy in an obese patient of body mass index 50 kg/m2 ‐ a video vignette

Abstract

BACKGROUND\nColorectal cancer operations in obese patients often pose a significant challenge in access and exposure due to the large body habitus. Change of position is difficult.\n\n\nOBJECTIVE\nTo present laparoscopic right hemicolectomy in severely obese patient and techniques used to overcome the difficulties.\n\n\nMETHODS\nA 74 years old female with body mass index (BMI) 50 underwent colonoscopy for anaemia which detected transverse colon cancer which was tattooed just distal to the cancer. Staging CT revealed this to be on the right side of transverse colon. An open approach, although less difficult as compared to a laparoscopic approach, would mean a longer post-operative recovery time and higher risk of wound complications. A laparoscopic approach though challenging was therefore considered. Access was gained using extra long ports as follows: umbilical 12mm open technique, right iliac fossa 5mm, left below umbilicus 11mm, left above umbilicus 5mm and an extra port just above umbilicus 5mm. Once access was obtained the operation was carried out using standard technique as shown in the video. The transverse colon was divided intracorporeally. The patient made uneventful recovery and went home on day 6 post-op.\n\n\nCONCLUSION\nDespite the challenges in obese patients, laparoscopic colorectal cancer surgery may have benefits over open approach from the patient s perspective. This article is protected by copyright. All rights reserved.