A rare and complex ileocolic vein variant managed with robotic surgery: Achieving surgical excellence in right colon cancer resection — A case report

摘要

INTRODUCTION: The ileocolic vein (ICV) is an important anatomical landmark during surgery for right colon cancer. However, surgeons sometimes encounter anatomical variations in the vascular anatomy. Robot-assisted surgery, featuring articulated instruments and advanced three-dimensional visualization, offers significant advantages in managing complex vascular variations. This is the first documented instance of a preoperatively diagnosed ICV anomaly that was successfully treated using robot-assisted laparoscopy. PRESENTATION OF CASE: A 68-year-old woman with a medical history of bronchial asthma and allergy to contrast media presented with right lower abdominal pain. Further evaluation revealed the presence of ascending colon cancer. Noncontrast abdominal computed tomography showed that the roots of the ileocolic vein and artery were anatomically separated. The ICV joined the accessory right colic vein (ARCV) and drained into the gastrocolic trunk of the Henle. The right colic artery coursed ventrally toward the trunk and ran parallel to the ARCV. The patient underwent robotic-assisted laparoscopic right hemicolectomy with D3 lymph node dissection. DISCUSSION: In rare cases where the ICV drains into the GCT, recognizing vascular anatomy preoperatively is crucial. While conventional laparoscopy is feasible, robot-assisted surgery enhances safety and precision through improved articulation and dexterity, making it advantageous in anatomically complex situations. CONCLUSION: We performed robot-assisted laparoscopic right hemicolectomy for ascending colon cancer with anatomical variations in the ICV draining directly into the gastrocolic trunk. The robot-assisted approach enabled safe and precise dissection despite the vascular anomaly owing to its articulated instruments and enhanced visualization.