da Vinci Robot Assisted Low Anterior Resection with Diverting Loop Ileostomy

da Vinci Xi robot assisted low anterior resection with diverting loop ileostomy

Rectal adenocarcinoma after neoadjuvant chemoradiation

Patients with history of prior abdominal surgeries and with significant adhesions; Patients requiring emergency surgery; Patients who cannot tolerate insufflation or prolonged operative times

Robotic Stapler
Robotic Surgical System

Preoperative subcutaneous heparin and oral Entereg 12mg The patient is laid supine in modified lithotomy position with both arms tucked. Cystoscopy with placement of bilateral ureteral stents by urology. Flexible sigmoidoscopy is performed to confirm the location of the tumor, which had previously been tattooed. In this patient, it is reduced to an ulcer, which is approximately 6cm from the anal verge.

Colonoscopy to determine tumor distance from anal verge and to rule out synchronous lesions. CT chest/abdomen/pelvis to look for metastatic disease. Preoperative medical and cardiac risk stratification.

A supraumbilical incision is made for the camera port, the abdomen is entered with the open Hasson technique. A robotic trocar is inserted and insufflation is induced to 15mmHg. Another trocar is placed in the right lower quadrant. and this site will be used for the loop ileostomy. Two additional trocars are placed in line with the umbilicus at the midclavicular line and at the left lateral abdomen. Two 5mm assist ports are placed in the suprapubic midline and the right upper quadrant. The da Vinci robot is then docked.

Risk of ureteral injury, difficulty with controlling significant bleeding

Risk of ureteral injury, difficulty with controlling significant bleeding

N/A