Place the patient on the operating table with arms tucked to the sides, in a modified lithotomy position. The hips should be only minimally flexed with the thighs at the level of the abdominal wall. This allows the surgeon and assistants to have unrestricted access to the patient from both sides and between the legs. Securely fasten the patient to the table because laparoscopic exposure often relies on exaggerated table positioning. Place monitors on either side of the head of the table. The surgeon will stand on the side opposite to the side of resection, and the assistant will stand on the other side.

For a right colon resection, three basic port sites are used: umbilical, left upper quadrant, and left lower quadrant (Fig. 82.1A). Additional sites that may be useful intraoperatively are located in the right upper quadrant, right lower quadrant, and occasionally in the high left upper quadrant just inferior to the costal margin. After a pneumoperitoneum has been established and 10- to 12-mm cannulas are placed in the three basic sites, laparoscopic exploration should be performed.

Place a straight (0 degree) laparoscope through the umbilical port site. Optimal passive exposure is obtained by placing the patient in a steep Trendelenburg position with the table rotated to the left. Retract the cecum medially using atraumatic bowel clamps. Elevate and incise the peritoneum along the line of Toldt with electrocautery scissors or ultrasonic shears (Fig. 82.2A). As the dissection continues, more distal portions of the right colon will need to be retracted to maintain good traction and countertraction. Divide all adhesions, however flimsy, to allow complete mobilization.

Continue this dissection to the region of the hepatocolic ligament. This region is more vascular and is divided hemostatically most easily with the ultrasonic scissors. With full mobilization, visualize the ureter, Gerota’s fascia, and the duodenum.

Place the patient in reverse Trendelenburg position with the table in neutral rotation. Grasp the transverse colon and retract it inferiorly to place the gastrocolic ligament on traction. The omentum forming the gastrocolic ligament can be divided most easily from the region of the middle colic vessels to the hepatocolic ligament using the ultrasonic scissors.

If intracorporeal ligation of the vessels is planned, grasp the hepatic flexure and retract it superiorly toward the anterior abdominal wall. This places the right mesocolon on traction, and the right colic vessels can be observed tenting the mesentery. Divide the mesentery lateral to the vessels with the ultrasonic scissors. Introduce an endoscopic vascular linear cutting stapling device from the left lower quadrant port. Pass the vascular pedicle into the jaws of the stapler, taking care to visualize the tips of the stapling device behind the vascular pedicle to avoid inadvertent incorporation of adjacent structures into the staple line (Fig. 82.2B).