Rectal cancer with invasion of adjacent pelvic organs is uncommon and poses significant operative challenges. Multimodal treatment combining neoadjuvant therapy and precise surgical technique is often required to achieve negative margins while preserving function.
We present a video of an 80-year-old female with low rectal adenocarcinoma (ypT4bN0M0) invading the posterior vaginal wall following chemoradiotherapy. A laparoscopic abdominoperineal resection with en bloc partial vaginectomy was performed, followed by reconstruction using a left gracilis myocutaneous flap. The minimally invasive approach provided excellent pelvic exposure and facilitated accurate dissection despite post-radiation fibrosis.
The patient had an uneventful postoperative recovery and was discharged on postoperative day 14 with no complications. Pathology confirmed R0 resection with no nodal involvement. At 6-month follow-up, the patient remained disease-free with satisfactory functional recovery.
This case demonstrates that, in selected patients and experienced centers, laparoscopic APR combined with reconstructive techniques offers a safe and effective option for locally advanced rectal cancer invading the vagina.
We present the case of a 70-year-old male with a presacral tumor known to be recurrent prostate cancer with an operative plan of a low anterior resection versus abdominoperineal resection. Intraoperatively, the presacral tumor was adherent to both the sacrum and rectum. Careful dissection of the tumor off of the sacrum allowed for full mobilization of the colon and rectum, which in turn allowed for a stapled coloanal anastomosis with preservation of the sphincter complex and restoration of function.
We present a case of a 60-year-old male with low-lying rectal cancer initially staged as a T4b tumor with concern for seminal vesicle invasion. A multidisciplinary decision was made to proceed with a jejunal-sparing operation, resecting only the seminal vesicles to preserve urinary continence. The anatomy of the Denonvilliers’ fascia remains controversial, with important implications for the surgical management of rectal cancers affecting adjacent urogenital structures. The anterior and posterior layers of the Denonvilliers’ fascia were successfully dissected, preserving the seminal vesicles and prostate. Pathology confirmed a mucinous adenocarcinoma with negative margins, and the patient is scheduled for ileostomy reversal. This case highlights how meticulous robotic-assisted dissection of the Denonvilliers’ fascia can avoid the need for urostomy and colostomy, preserving urinary function and demonstrating the potential benefits of improved anatomical understanding in pelvic surgery.
Stoma prolapse is an increase in the size of the stoma secondary to intussusception of the proximal bowel segment. Strangulation and ischemia of the prolapsed segment have been reported as complications.
This is the case of a 58-year-old man with multiple comorbidities who was diagnosed with an adenocarcinoma of the ascending colon with hepatic metastasis. He was considered unable to start conversion chemotherapy because of his cardiovascular comorbidities and was therefore under paliative chemotherapy.
Patient came into emergency room with an acute bowel obstruction and underwent a loop ileostomy as a diversion procedure. Following up the procedure, the patient developed an acute on chronic kidney failure because of dehydration from high output ileostomy. In the postoperative day 17, patient presented with an acutely incarcerated prolapsed afferent limb of the loop ileostomy. Attempts at reduction were unsuccessful.
Herein we present a simple, safe, and fast approach for correcting a prolapsed loop or terminal stoma using a step-wise application of linear staplers.
When laparotomy and/or stoma reversal is not appropriate, local revision of stoma prolapse provides a low-risk and high-benefit alternative solution.
Contributors: Benjamin Biteman and Vincent Obias
Robotic Transanal minimally invasive surgical removal of 1.8cm villous adenoma with high grade dysplasia at 22cm.
DOI#:https://doi.org/10.17797/kzimoid3xj
Editor Recruited By: Vincent Obias
Contributors: Nell Maloney Patel
We present a case of a seventy-two year old female found on colonoscopy to have multiple polyps and an ascending colon mass that was biopsy proven adenocarcinoma who underwent a robotic assisted right hemicolectomy with intracorporeal anastomosis.
DOI# http://dx.doi.org/10.17797/54hba94993
Editor Recruited by: Vincent Obias
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
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
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
Contributors: Craig Rezac, MD
This video demonstrates the basic steps of a Robotic-Assisted Total Abdominal Colectomy for Ulcerative Colitis using the da Vinci Xi Robotic System.
DOI: http://dx.doi.org/10.17797/zr41dcfdmt
