Standardized approach to laparoscopic right colectomy: Outcomes in 70 consecutive cases

Abstract

BACKGROUND: The purpose of this article is to describe a standard operative technique, postoperative care plan, and outcomes for laparoscopic right hemicolectomy. STUDY DESIGN: A consecutive series of patients requiring laparoscopic right colectomy for neoplasia from March 1999 to April 2003 at the Cleveland Clinic Foundation, Cleveland, OH, were analyzed. Data collected included age, gender, indication for surgery, American Society of Anesthesiology class, body-mass index, operative duration, length of hospital stay, complications, mortality, and 30-day readmission rate. Operative steps and instrumentation for the procedure were standardized. Conversion was performed when a sequential step could not be completed in a reasonable time frame. A standard perioperative care plan was used. RESULTS: From March 1999 through April 2003, 70 laparoscopic right hemicolectomies were attempted and 64 (90.1%) were completed. Indications for resection were cancer (30) and polyps (38). The mean operative time was 85 +/- 32 minutes. Mean length of hospital stay was 3.2 +/- 2 days for completed cases and 4.3 +/- 2 days for converted cases. Anastomotic leaks occurred in 2 (2.8%) patients. The morbidity rate including the anastomotic leaks was 7.1%. There were no operative mortalities or port site tumor recurrences. CONCLUSIONS: Results indicate that a structured approach to laparoscopic right colectomy is associated with reasonable operative times, acceptable morbidity, and reductions in hospital stay.