Robot-Assisted Low Anterior Resection and Colovesical Fistula Repair

Complicated diverticulitis, carcinoma of the rectosigmoid colon higher than 5cm from the anal verge.

Diseased colon less than 5cm from the anal verge, 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)

Patient is placed in the supine position with both arms tucked. The robot is docked on the patient's right shoulder

CT scan, colonoscopy, cystoscopy

Bladder, ureters, white line of Toldt, inferior mesenteric vessels, splenic flexure

Advantages: Superior retraction, visualization and dissection
Disadvantage: longer procedure/anesthesia time, potentially more cost

Injury to the ureters, spleen, anastomotic leak, bladder leak, blood loss, infection

No conflicts to disclose

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