da Vinci Assisted Low Anterior Resection and Colovesical Fistula Repair
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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- Peer reviewed
Author: June Hsu
Published:
Specialties: General Surgery, Robotic Surgery
Schools: Rutgers- Robert Wood Johnson Medical School
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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 had previously been conducted with laparoscopy, or open surgery, are becoming further improved upon in robotic surgery. This video demonstrates two such procedures, from different specialities, being performed; the low anterior resection and colovesical fistula repair.
Procedure
Robot-Assisted Low Anterior Resection and Colovesical Fistula Repair
Indications
Complicated diverticulitis, carcinoma of the rectosigmoid colon higher than 5cm from the anal verge.
Contraindications
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)
Instrumentation
Setup
Patient is placed in the supine position with both arms tucked. The robot is docked on the patient's right shoulder
Preoperative Workup
CT scan, colonoscopy, cystoscopy
Anatomy and Landmarks
Bladder, ureters, white line of Toldt, inferior mesenteric vessels, splenic flexure
Advantages/Disadvantages
Advantages: Superior retraction, visualization and dissection
Disadvantage: longer procedure/anesthesia time, potentially more cost
Complications/Risks
Injury to the ureters, spleen, anastomotic leak, bladder leak, blood loss, infection
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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