Robotic Assisted Redo Rectopexy and Low Anterior Resection

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

Low anterior resection and rectopexy is the optimal treatment for well functioning patients with rectal prolapse. Reoperations for rectal prolapse may be challenging due to significant adhesions. Use of the robot for low anterior resection and rectopexy is safe, feasible and may be more useful than laparoscopy especially in challenging cases.

DOI:http://dx.doi.org/10.17797/vkp7axh60l

Advanced

Procedure

Robotic assisted redo rectopexy and low anterior resection.

IMA ligation and sigmoidectomy was performed to eliminate the redundancy in the left colon that contributed to the prolapse. Resection with rectopexy has the lowest recurrence rate for prolapse. Rectopexy done before the anastomosis ensures a more adequate suspension of the posterior pelvic floor. If the anastomoses is done first it covers the sacral promontory making the rectopexy more difficult to do. We have not had tearing of sutures.

Indications

rectal prolapse

Contraindications

Instrumentation

Setup

Dorsal lithotomy position, preoperative cystoscopy and bilateral ureteral stents, robot docked to the left of the patient

Preoperative Workup

Physical exam revealing rectal prolapse, colonoscopy

Anatomy and Landmarks

peritoneal reflection, sacral promontory, white line of Toldt

Advantages/Disadvantages

The main advantages of the robotic system for rectal prolapse are improved magnification and picture quality, decreased surgeon fatigue, easier access to the pelvis with articulating instruments and significantly easier suturing. The main disadvantages include increased cost and operative time.

Complications/Risks

Disclosure of Conflicts

Acknowledgements

References

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