When a patient needs a hemicolectomy — removal of part of the colon, whether on the right or left side — the operation doesn't end once the diseased segment is out. The two remaining ends of healthy bowel still need to be rejoined. How that reconnection is performed is one of the clearest markers of a surgeon's laparoscopic and robotic skill, and it has a real, measurable effect on a patient's recovery.
First, the basics
A hemicolectomy removes a diseased portion of the colon — most commonly for colorectal cancer, but also for severe diverticular disease or other conditions. Once the affected segment is removed, the two healthy ends of bowel must be joined back together. This join is called an anastomosis. The question is: where, exactly, does that joining happen?
Two ways to perform the anastomosis
In laparoscopic and robotic hemicolectomy, there are two fundamentally different approaches to completing this step — and the difference between them matters far more than many patients realise.
Extracorporeal Anastomosis
- The bowel is mobilised laparoscopically or robotically
- The diseased segment is then pulled out of the abdomen through a small laparotomy incision
- The anastomosis is performed outside the body, by hand, in open conditions
- The reconnected bowel is then returned to the abdomen
- Requires a small to moderate extraction incision regardless of how minimally invasive the rest of the operation was
Intracorporeal Anastomosis
- The entire anastomosis is constructed inside the abdomen, using laparoscopic or robotic instruments
- The bowel is never pulled out through an extraction incision to be joined
- Only the specimen itself needs to exit the body — through a much smaller incision, or via NOSES with no abdominal incision at all
- The bowel is positioned and joined exactly where it naturally lies in the abdomen
Why intracorporeal anastomosis demands a higher level of skill
Performing the anastomosis entirely inside the abdomen is technically far more demanding than bringing the bowel outside to do it by hand. It requires advanced laparoscopic or robotic suturing and stapling skill, precise three-dimensional spatial awareness, and the experience to manage the bowel safely under indirect vision throughout. This is precisely why most surgeons in Malaysia who perform laparoscopic hemicolectomy still default to the extracorporeal approach — it's the more familiar, lower-skill-ceiling option.
Advanced instrument control
Constructing a secure, leak-proof anastomosis using laparoscopic staplers or robotic suturing — entirely within the confined working space of the abdomen — requires significantly more refined technical skill than performing the same step by hand outside the body.
Spatial precision
The surgeon must correctly orient and align both ends of bowel using only the laparoscopic or robotic view — without the tactile feedback available when working with tissue in hand, outside the body.
Procedural consistency
An intracorporeal anastomosis demands a reliable, repeatable technique — there's no opportunity to "step outside the difficulty" by exteriorising the bowel if a step becomes technically challenging.
Why it matters for the patient
This isn't merely a technical preference — it translates into real, tangible benefits for the person on the operating table.
Smaller incision
Without the need for an extraction-sized laparotomy, the specimen can exit through a much smaller incision than extracorporeal technique requires.
No extraction wound at all
Combined with NOSES, the specimen can be removed through a natural orifice — meaning no additional abdominal incision is needed whatsoever.
Natural bowel positioning
Because the bowel is joined exactly where it lies inside the abdomen, there's no risk of twisting or tension that can occasionally occur when bowel is pulled out, joined, and replaced.
Less post-operative pain
Smaller wounds are consistently associated with less pain, lower analgesic requirements, and a smoother recovery in the days following surgery.
Combining Intracorporeal Anastomosis with NOSES
Dr Cha takes this technique a step further by combining intracorporeal anastomosis with NOSES (Natural Orifice Specimen Extraction Surgery) wherever appropriate — removing the diseased specimen through the anus or vagina rather than any abdominal incision at all. The result is a hemicolectomy completed through keyhole ports only, with no extraction wound whatsoever. Read more about NOSES on the Colorectal Surgery page.
Right-sided vs left-sided hemicolectomy
This principle applies equally whether the diseased segment is on the right side of the colon (right hemicolectomy) or the left side, including the sigmoid colon (left or sigmoid hemicolectomy). The anatomy and specific technical steps differ between the two, but in both cases, Dr Cha's default approach is to complete the anastomosis intracorporeally — keeping the entire reconstructive step within the controlled environment of the abdomen, rather than exteriorising the bowel through an extraction incision.
What this means if you're considering surgery: when discussing a hemicolectomy with your surgeon, it's entirely reasonable to ask whether the anastomosis will be performed intracorporeally or extracorporeally. The answer is a meaningful indicator of the surgical approach you can expect — and of the incision size, recovery course, and overall experience that follows.
Dr Cha Kar Huei
Consultant Bariatric, Colorectal & Laparoscopic Surgeon, Hospital Picaso