da Vinci Assisted Extended Right Hemicolectomy and End Ileostomy

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
  • Clearly annotated and narration is a must in these videos
  • These have clear but concise abstracts are not able to be indexed in PubMed
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Author: June Hsu
Published:
Specialties: General Surgery, Robotic Surgery
Schools: Rutgers- Robert Wood Johnson Medical School
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Basic Info

Contributors: Jimmy Lin and  Craig Rezac

Robotic surgery offers benefits to both patient and surgeon by allowing smaller incisions and faster recovery time, to better accuracy, flexibility and control.  Many procedures which have previously been conducted with laparoscopy, or open surgery, are becoming further improved in robotic surgery. This video demonstrates once such procedure, the extended right hemicolectomy.

DOI# http://dx.doi.org/10.17797/rv3nkbech0

Authors Recruited By: Vincent Obias. MD. MS

Advanced

Procedure

da Vinci Assisted Extended Right Hemicolectomy and End Ileostomy

Indications

The patient is a 22 year old man with a long standing history of Crohn's Disease causing high grade strictures from his terminal ileum to transverse colon resulting in severe weight loss, difficulty with diet and abdominal discomfort. Given the severity of his disease, and failure of medical management, the patient elected to proceed with a robotic extended right hemicolectomy and end ileostomy. Prior to surgery, patient had a colonoscopy which demonstrated one of the high-grade strictures that did not allow passage of the colonoscope into the proximal transverse colon. This stricture was tattooed at the time of the colonoscopy.

Contraindications

Unstable patients, large phlegmonous mass, obstruction, perforation or ileus leading to massive bowel distension and loss of domain, carcinomatosis, morbid obesity (relative), multiple previous abdominal surgical procedures (relative), extensive abdominal adhesions (relative)

Instrumentation

Setup

Patient is placed in the supine position with both arms tucked. The robot is docked on the patient�s right shoulder.
Pre-operative workup

Preoperative Workup

Colonoscopy

Anatomy and Landmarks

White line of Toldt
Right ureter
Hepatic flexure
Duodenum
Pancreatic head

Advantages/Disadvantages

Advantages: Superior retraction, visualization and dissection.

Disadvantages: Longer procedure time (for robotic setup), potentially more cost

Complications/Risks

Blood loss, infection, damage to nearby structures (right ureter/kidney, duodenum), stricture, high-output ileostomy

Disclosure of Conflicts

No conflicts to disclose

Acknowledgements

References

Courtney M. Townsend, Jr., MD; R. Daniel Beauchamp, MD; B. Mark Evers, MD; and Kenneth L. Mattox, MD, 2012, Sabiston Textbook of Surgery, 19th Edition. Suanders

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