Low Anterior Resection for Diverticulitis

Video Type: CVideo
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Author: Michelle DeLeon, MD
Published:
Specialties: General Surgery, Robotic Surgery
Schools: Rutgers- Robert Wood Johnson Medical School
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Basic Info

Contributors: Craig Rezac, MD

Treatment for recurrent or complicated diverticulitis is surgical resection. Minimally invasive techniques are associated with decreased length of stay and decreased post operative pain. However, laparoscopic low anterior resection is challenging especially in the narrow pelvis. Robotic surgery may overcome these obstacles and allow more surgery for divertiuclitis to be performed minimally invasively.

These surgeons always do a LAR for diverticulitis because they transect on the proximal rectum. They take down the lateral stalks in order to mobilize the rectum and get the eea stapler through the rectum easier.

Bilateral ureteral stents are routinely placed to better identify the ureters. This is especially important in cases of chronic/active diverticulitis or diverticulitis that has been complicated by abscess or fistula. This is the preference of the surgeon.

DOI#  http://dx.doi.org/10.17797/y1f1omu3mt

Advanced

Procedure

Robotic assisted low anterior resection

Indications

Recurrent diverticulitis, complicated diverticulitis

Contraindications

Perforation, fecal peritonitis, extensive previous surgical history (relative)

Instrumentation

Setup

Modified dorsal lithotomy, preoperative bilateral ureteral stents, robot docked to the left of the patient

Preoperative Workup

Cat scan of the abdomen and pelvis, colonoscopy

Anatomy and Landmarks

Sacral promontory, peritoneal reflection, common iliac bifurcation, white line of Toldt

Advantages/Disadvantages

The main advantages of the robotic system in the surgical treatment of diverticulitis include improved magnification and picture quality, decreased surgeon fatigue and easier access to the pelvis with articulating instruments. The main disadvantages of the robotic system for diverticulitis may include increased cost and increased operative time.

Complications/Risks

The major risks to the procedure include anastomotic leak and ureteral injury.

Disclosure of Conflicts

No disclosures

Acknowledgements

References

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