Completely Robotic Total Proctocolectomy and Ileal Pouch Anal Anastomosis

Video Type: CVideo
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Author: Michelle DeLeon, MD
Published:
Specialties: General Surgery, Robotic Surgery
Schools: Rutgers- Robert Wood Johnson Medical School
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Basic Info

Contributors: Nell Maloney Patel, MD and Craig Rezac, MD

There is little role for the use of minimally invasive techniques in the emergent setting for ulcerative colitis. However, for elective procedures, studies have shown that laparoscopic restorative proctocolectomy with IPAA is equivalent to open IPAA with regards to safety and feasibility, and that laparoscopic IPAA is associated with shorter recovery times, earlier return to bowel function, less post operative pain and a better cosmetic result. However laparoscopic approaches are difficult especially in the narrow pelvis. These challenges maybe overcome with the daVinci robotic system.

DOI:http://dx.doi.org/10.17797/r1oi8fx5c2

Editor Recruited by: Neil Tanna

Advanced

Procedure

completely robotic total proctocolectomy with ileal pouch anal anastomosis

Indications

Indications for elective robotic surgery in patients with ulcerative colitis include intractable disease refractory to medical therapy, dysplasia, carcinoma, and severe malnutrition.

Contraindications

Contraindications to robotic surgery in patients with ulcerative colitis include perforation, hemodynamic instability, fulminant colitis in the emergent setting and extensive previous surgical history (relative contraindication).

Instrumentation

Setup

Dorsal lithotomy position, cystoscopy and bilateral ureteral stents, robot docked to the left of the patient

Preoperative Workup

Preoperative workup includes evaluation by a gastroenterologist, colonoscopy, confirmed diagnosis of ulcerative colitis and cat scan of the abdomen and pelvis.

Anatomy and Landmarks

sacral promontory, white line of Toldt, peritoneal reflection, seminal vesicles, dentate line

Advantages/Disadvantages

The main advantages of robotic total proctocolectomy and IPAA include improved magnification and picture quality, decreased surgeon fatigue and easier access to the pelvis with articulating instruments. The main advantage of the Xi daVinci system over the Si system is the overhead boom which allows the robotic arms to rotate as a group, enabling the surgeon to access all areas of the abdomen easily without having to physically re-dock the robotic base. This is extremely helpful in a total proctocolectomy where each region of the abdomen needs to be explored. The main disadvantages are operative time and cost.

Complications/Risks

Disclosure of Conflicts

Acknowledgements

References

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