Completely Robotic Total Proctocolectomy and Ileal Pouch Anal Anastomosis
Contributors: Nell Maloney Patel, MD and Craig Rezac, MD
There is little role for the use of minimally invasive techniques in the emergent setting for ulcerative colitis. However, for elective procedures, studies have shown that laparoscopic restorative proctocolectomy with IPAA is equivalent to open IPAA with regards to safety and feasibility, and that laparoscopic IPAA is associated with shorter recovery times, earlier return to bowel function, less post operative pain and a better cosmetic result. However laparoscopic approaches are difficult especially in the narrow pelvis. These challenges maybe overcome with the daVinci robotic system.
DOI:http://dx.doi.org/10.17797/r1oi8fx5c2
Editor Recruited by: Neil Tanna
completely robotic total proctocolectomy with ileal pouch anal anastomosis
Indications for elective robotic surgery in patients with ulcerative colitis include intractable disease refractory to medical therapy, dysplasia, carcinoma, and severe malnutrition.
Contraindications to robotic surgery in patients with ulcerative colitis include perforation, hemodynamic instability, fulminant colitis in the emergent setting and extensive previous surgical history (relative contraindication).
Robotic Surgical System
Dorsal lithotomy position, cystoscopy and bilateral ureteral stents, robot docked to the left of the patient
Preoperative workup includes evaluation by a gastroenterologist, colonoscopy, confirmed diagnosis of ulcerative colitis and cat scan of the abdomen and pelvis.
sacral promontory, white line of Toldt, peritoneal reflection, seminal vesicles, dentate line
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