Difficult Dissection during a Low Anterior Resection

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
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Author: Michael Scott
Published:
Specialties: Gastrointestinal Surgery, General Surgery, Minimally Invasive, Robotic Surgery
Schools: Rutgers- Robert Wood Johnson Medical School
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Basic Info

It is well-accepted that recurrent or complicated diverticulitis is an indication for surgical resection. Minimally invasive techniques, like the daVinci robot, have been developed to enable better visualization of the pelvis with articulating instruments. However, many times, the minimally invasive approach is deferred for cases of severe disease and adhesions. This video demonstrates the dissection of a significantly diseased sigmoid colon during a robotic-assisted low anterior resection. As you can see, with surgeon experience and patience, even complicated cases can be done successfully using the robot.

The patient is a 65-year-old male with a history of multiple episodes of diverticulitis. The most recent episode was complicated by a pericolonic abscess, which was treated non-operatively with drainage and antibiotics. He presents 2 months later for an elective resection.

Advanced

Procedure

Robotic-assisted low anterior resection

Indications

Recurrent or complicated diverticulitis

Contraindications

Contraindications for the robotic approach may include perforation, fecal peritonitis, extensive previous surgery, inability to tolerate pneumoperitoneum

Instrumentation

Setup

Modified dorsal lithotomy, pre-operative placement of left uretral stent, robot docked at the left, 3 robotic ports and 1 assistant port placement

Preoperative Workup

CT scan of abdomen/pelvis, colonoscopy

Anatomy and Landmarks

Advantages/Disadvantages

Advantages include better visualization of pelvis anatomy with articulating instruments, decreased length of stay post-operatively
Disadvantages include longer operative time and increased cost

Complications/Risks

Disclosure of Conflicts

No disclosures

Acknowledgements

Thanks to Osvaldo Zumba, MD and Michelle Deleon, MD for their advice and guidance throughout the process

References

Deleon, Michelle. "Low Anterior Resection for Diverticulitis." Csurgeries.com. Contributor: Craig Rezac. 31 March, 2016.

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