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The transverse colon crosses the upper abdomen between the liver and the spleen, under the stomach and over the pancreas. This page explains how a robotic operation for cancer here is chosen and done: extended right or extended left, the middle colic vessels, the neighbouring organs, the join and the first week. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 10 October 2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
Shah’s Gastro, Cancer & Robotic Surgery Centre. Super-specialty training in surgical gastroenterology, two higher degrees in it, and 18 years of experience in GI and cancer surgery. Every colon cancer is discussed at the tumour board once staging is complete, and Dr Harsh Shah performs the operation himself.
In short
The transverse colon hangs across the upper abdomen, from the bend under the liver to the bend under the spleen.
It lies just below the stomach and in front of the pancreas, and most of its blood arrives through one set of vessels, the middle colic vessels, which rise from behind the pancreas.
A tumour near the liver end, or in the first part of the transverse colon, is removed by an extended right hemicolectomy, with the middle colic vessels tied at their origin. A tumour at the far end, near the spleen, needs either an extended right or an extended left operation. The tumour board chooses between them on the scans.
What the robot adds here is a steady, magnified view at the root of the middle colic vessels on the pancreas. It also gives wristed instruments for freeing both bends of the colon from the liver, stomach and spleen. A tumour that has grown into the stomach or pancreas is removed together with that part, usually by open surgery.
The transverse colon is the part of the large bowel that crosses from right to left.
It is the longest and most mobile segment, it touches more organs than any other, and it sits where the blood supplies of the right and left colon meet. Each of these shapes the operation.
| Neighbour | How it is attached | Why it matters in the operation |
|---|---|---|
| Stomach | Joined by the apron of fat (omentum) along its lower curve. | The apron is divided to reach the vessels; a tumour stuck to the stomach is removed with part of it. |
| Pancreas and duodenum. | The fatty fold of the colon lies on them. | The middle colic vessels rise at the lower border of the pancreas; the pancreas is kept untouched. |
| Liver and gallbladder. | At the right-hand bend. | The right bend is freed for an extended right operation. |
| Spleen and tail of the pancreas. | At the left-hand bend. | The left bend is freed gently, because the spleen bleeds easily. |
Because the transverse colon is so mobile, a tumour in its middle can sit lower in the abdomen than expected. The ink tattoo placed beside the tumour at colonoscopy, and the CT, are what pin it to its true position before the operation is chosen.
The aim is to remove the tumour with every lymph node that drains it, while keeping as much healthy bowel as possible.
Lymph nodes follow the blood vessels, so the vessel that feeds the tumour decides the operation. The protocol this centre follows sets it out by site.
| Where the tumour is | Operation | Vessels tied at their origin | The join |
|---|---|---|---|
| Bend under the liver, or the first part of the transverse colon. | Extended right hemicolectomy. | The right-sided vessels and the middle colic vessels. | End of the small bowel to the remaining colon. |
| Far end of the transverse colon, near the spleen. | Extended right or extended left hemicolectomy, chosen on the scans. | The middle colic vessels, with or without the left colic. | Depends on the operation chosen. |
| Caecum or ascending colon. | Right hemicolectomy | Explained on the right hemicolectomy page. | Small bowel to transverse colon. |
| Bend under the spleen, descending colon. | Left hemicolectomy or an extended operation. | Explained on the left hemicolectomy page. | Colon to colon or to the top of the rectum. |
A tumour near the spleen end sits where the two blood supplies meet, so its lymph nodes can drain either way. The tumour board looks at the vessel pattern on the CT and decides which operation clears the nodes with the least bowel lost.
You may read about removing the transverse colon alone. The protocol followed here chooses between an extended right and an extended left operation. This removes the lymph nodes along the main vessels. If a shorter operation is ever proposed for you, the reason is explained at the consultation.
The middle colic artery and vein rise from the main vessels of the small bowel at the lower border of the pancreas.
Tying them at that origin, and lifting away the fatty fold with its lymph nodes intact, makes it a complete cancer operation. This step is done on the surface of the pancreas.
The pancreas lies directly beneath this fold and is not entered. The dissection follows the natural plane between the fold and the front of the pancreas. The lymph nodes come away in one piece, while the pancreas and the duodenum beside it stay untouched.
Close to the same spot, veins from the stomach and the right colon join into a short common trunk before entering the main vein. Only the branches that drain the colon are divided; the vein of the stomach is kept wherever possible.
The protocol requires a minimum number of lymph nodes in the specimen for an accurate stage. Tying the vessels at their origin is what brings those nodes out. A count below the minimum is itself treated as a high-risk feature on the report.
The stomach sits directly above the transverse colon, joined to it by the apron of fat.
In most operations the stomach is not removed: the apron is divided along the stomach’s lower curve, opening the space behind it, and the stomach’s own blood supply is kept.
If the scans or the operation show the tumour growing into the stomach wall, the pancreas or another neighbour, that part is removed in one block with the colon. Peeling a tumour off a neighbouring organ risks leaving cancer behind, so it is never done. A tumour like this is discussed at the tumour board before surgery, and the operation is usually open.
Whether part of another organ may be needed is part of your consent. It is explained at the consultation once the scans have been read, so the possibility is never a surprise.
The extent of the operation is the same with or without the robot. In the transverse colon it gives control in four places. Here the work is fine and the organs are close together: the vessel root on the pancreas, the space behind the stomach, the two bends, and the check of the blood supply before joining.
The robot gives no sense of touch. So the ink tattoo beside the tumour shows its position, and the margins are judged by sight and on the scans.
You lie on your back with the table tilted head-up, so the small bowel falls downwards and the transverse colon hangs clear.
The table is then tilted towards one side or the other as the work moves between the two bends. The port positions are planned from the scans so that the arms reach the vessel root and both bends.
Because the operation reaches across the whole upper abdomen, the robot is docked with care. Its arms can then be re-aimed from the vessel root to either bend without moving the robot. This is planned before the operation from the scans, since the transverse colon varies more in position from person to person than any other segment.
At the end the specimen is placed in a bag and removed through a short cut, usually low across the abdomen. A cut in the middle is used when more length is needed. The low cut is less painful and less prone to a hernia.
The order is: check for spread, open the space behind the stomach, tie the middle colic vessels at their origin, lift the fatty fold off the pancreas, free the bends, divide the bowel where the blood supply is good, and join the two ends.
A join after a transverse colon operation brings together two ends that now rely on blood supply from further away.
It must reach without stretching and have a good blood supply on both sides. That is why both bends are often freed and why the dye check is used every time.
| Measure | What it protects |
|---|---|
| Freeing one or both bends of the colon. | A join without tension. |
| Dye check of both ends before joining. | A good blood supply on each side. |
| Bowel preparation with antibiotic tablets the day before. | Fewer wound infections and fewer leaks. |
| A temporary ileostomy, only when the join is judged less secure. | Time for a borderline join to heal; closed a few months later. |
Whether to close the gap left in the fatty fold after the specimen is removed is decided by the surgeon on the table. A stoma nurse marks a possible stoma site before every colon operation, even though most patients will not need one.
Keyhole surgery is the established standard for colon cancer and robotic surgery an accepted alternative in experienced hands. All three remove the same segment and the same lymph nodes.
For the transverse colon they differ in how the vessel root and both bends are reached, in the cut, and in recovery.
| Open | Keyhole | Robotic | |
|---|---|---|---|
| Cut | A long cut down the middle of the upper abdomen. | Ports and a short cut. | Ports and a short, usually low cut. |
| Vessel root on the pancreas. | Seen directly through the open abdomen. | Magnified, straight instruments. | Magnified, three-dimensional, wristed instruments. |
| Reaching both bends. | A longer cut. | Repositioning between the two sides. | Arms re-aimed without moving the robot. |
| Blood-supply check before joining. | By eye | Dye where available. | Dye built into the camera. |
| Blood loss | Higher | Lower | Lower |
| Lymph nodes removed. | The same | The same | The same |
| Hospital stay and return to work. | Longest | Shorter | Shorter |
| Cost | Lowest | Moderate | Highest, for the robotic instruments. |
When to return to work and to lifting depends on the job and on the cut, and is planned with you at discharge.
A transverse colon cancer sometimes first shows itself as a blocked or bleeding bowel. These are handled on the emergency pathway, often by open surgery.
A bulky tumour stuck to the stomach or pancreas, or an abdomen scarred by earlier operations, is also usually operated open.
| Situation | What is done |
|---|---|
| Blockage from a tumour on the right half. | Removal with an immediate join between small bowel and colon, which is usually safe. |
| Blockage from a tumour near the spleen end, in a fit patient. | Removal with a join, sometimes with a temporary stoma, or a stoma alone if the patient is unstable. |
| Blockage near the spleen end, in a frail patient or with spread elsewhere. | A stent through a scope, as a bridge to a planned operation or as the treatment itself. |
| Burst bowel or heavy bleeding from the tumour. | Same-day decision by the consultant surgeon; a burst bowel needs removal, a washout and usually a stoma. |
| Tumour grown into the stomach, pancreas or another organ. | Tumour board discussion, then removal in one block, usually open. |
If bleeding cannot be controlled at once, or the plane is lost during a robotic operation, it is converted to open. That is a sound operative judgement and part of the consent.
Recovery follows a set plan: up on the day of surgery, eating from the next day, no tube through the nose and usually no drain.
Most patients go home around the fourth or fifth day after an uncomplicated operation.
| When | What happens |
|---|---|
| Day of surgery. | Sitting out of bed a few hours after the operation; clear fluids; chewing gum; pain relief with minimal opioids. |
| Next day | Normal food as tolerated; walking four times; urine catheter out; drip stopped. |
| Second day | Full diet; pain tablets only; passing wind. |
| Third day | A bowel action; a drain removed if one was placed; discharge checklist. |
| Fourth or fifth day. | Home once eating, walking alone and pain controlled on tablets, and able to manage a stoma if one was made. |
A fast pulse, fever, or abdominal pain that grows between the third and seventh days can mean a leak at the join. It is checked the same day with a scan. Milky fluid in a drain, bloating with vomiting, or very little urine are each checked the same day too. These risks, and the figures that apply to you, are discussed at the consent visit.
The report is discussed about two weeks after the operation. It states the lymph nodes examined, the margins, the mismatch-repair result and any high-risk feature, and these decide whether chemotherapy is advised. If it is, it starts within six to eight weeks of surgery.
| When | What is checked |
|---|---|
| At two weeks. | The wound, the pathology report, the chemotherapy referral if needed, stoma review, and the dietitian. |
| Every three months for three years. | Symptoms, weight, examination and the tumour-marker blood test. |
| Every six months in years four and five. | The same |
| Yearly | A CT scan of the chest, abdomen and pelvis. |
| At one year. | Colonoscopy, then at three years, then every five years if normal. |
★★★★★
“We came from Mp Indore for the treatment of Rectal cancer and Robotic surgery was done by Dr harsh shah....After surgery my son is good now. Heartly thankful to you sir...”
— Parasram Solanki, Google review, Google listing
★★★★★
“I had a truly positive experience with Dr. Harsh Shah. He is not only highly knowledgeable but also very compassionate and patient in explaining every detail. I underwent CRS HIPEC surgery under his care, and I couldn’t have asked for a better doctor. The entire process was smooth, and his expertise made a complex procedure feel manageable. Post-surgery recovery was well-monitored, and he was always available for any concerns. Highly recommend Dr. Harsh Shah for anyone needing advanced surgical oncology care.”
Akram Khan · Google review
★★★★★
“Excellent doctor for stomach cancer. We r very happy. Recommend for gastro cancer treatment in Ahmedabad”
Purshottam Meena · Google review
Quoted exactly as written on the centre’s Google listings: a family whose relative had robotic surgery for colon cancer, and two patients of Dr Harsh Shah treated for other abdominal cancers, followed by a patient speaking after colon cancer surgery.
A robotic operation for transverse colon cancer costs more than an open or keyhole one, because of the robotic instruments and staplers.
Removal of part of a neighbouring organ, a temporary stoma and its closure, a longer stay or a complication change the total. The office gives a written estimate once the plan is settled.
Cashless admission is arranged at Apollo Hospital, Bhat where your policy allows it, and the office prepares the pre-authorisation papers. Allow a day or two for robotic approval. Ask whether your policy covers robotic surgery and up to what limit. Bring the policy documents, photo identity, every report with the scans on disc, and a list of current medicines. For an estimate, call +91-63590-11009 or send the reports on WhatsApp.
Because it removes more than a standard right or left hemicolectomy: the transverse colon and the middle colic vessels are taken as well, so that every lymph node draining the tumour comes out.
Usually not. The fat joining the stomach to the colon is divided and the stomach is kept. Only a tumour grown into the stomach wall needs part of the stomach removed with it.
The artery and vein that carry most of the transverse colon's blood. They rise at the lower border of the pancreas and are tied at their origin to remove the lymph nodes along them.
Most patients do not. A temporary ileostomy is added only if the join is judged less secure, and it is closed a few months later.
No. Keyhole surgery is the established standard and the robot is used where it helps. A blocked or bleeding bowel, or a tumour stuck to the stomach or pancreas, is usually operated open.
Within six to eight weeks of the operation, once the pathology report has been discussed.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of scans and pathology reports, second opinions, follow-up and surveillance.
Google: 4.9 · 53 reviews
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Google: 5.0 · 25 reviews
Patients travel for colon cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
Send the colonoscopy, biopsy and CT reports ahead of your appointment, so the consultation starts with them already read. Which operation you need, and whether it is robotic, keyhole or open, is decided at the consultation after examination, and by the tumour board. Call +91-63590-11009 WhatsApp the office
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