We present the case of a 60-year-old male patient with a history of recurrent acute sigmoid diverticulitis episodes. Comorbidities were limited to suspected obstructive sleep apnea (OSAS). The patient did not exhibit pneumaturia, fecaluria, or recurrent urinary tract infections. Colonoscopy revealed sigmoid diverticulosis, while contrast-enhanced abdominal CT demonstrated a large sigmoid diverticulum adhered to the posterior bladder wall, suggestive of a pre-fistulous state.
Given the clinical presentation, we opted for surgical intervention, performing a robot-assisted hemicolectomy using the Da Vinci system. The surgery involved ligation of the inferior mesenteric artery and vein, followed by the mobilization of the left colon up to the splenic flexure. Subsequent meticulous dissection was carried out to separate the sigmoid colon from the bladder, to which it was tenaciously adhered. This revealed a diverticulum that had eroded the bladder wall down to the muscular layer. We resected the diverticulum from the sigmoid colon, leaving a portion adhered to the bladder wall.
The rectum was resected up to the peritoneal reflection using a linear stapler. To remove the remaining diverticulum fragment adhered to the bladder wall, the bladder was filled with a solution of physiological saline and methylene blue, facilitating safer dissection and visualization of potential suture lines. The fragment was cautiously dissected from the bladder wall, with no evidence of fistulas. The bladder wall was subsequently reinforced with a continuous suture using Stratafix PDS 2/0.
Following the removal of the surgical specimen, a termino-terminal colorectal anastomosis was created using a circular stapler. Postoperatively, the patient experienced an uneventful recovery, maintaining a urinary catheter until the 5th postoperative day with no signs of hematuria or fecaluria. Following catheter removal, diuresis was normal and spontaneous.
This case highlights the successful management of a complicated sigmoid diverticulum with robotic-assisted surgery, emphasizing the importance of meticulous dissection and bladder wall reinforcement in such cases.
Step into the world of advanced surgical procedures with our comprehensive video on Robot-Assisted One Anastomosis Gastric Bypass. This meticulously edited video guides you through each of the 10 standardized steps employed in our high-volume surgical unit, showcasing a state-of-the-art approach to gastric bypass surgery. The steps are:
Treitz Ligament Identification;
Biliary Loop Measurement;
His angle dissection;
Lesser Sac Opening;
Gastric Pouch Creation;
Gastrojejunostomy;
Gastrojejunostomy Fixation;
Methylene Blue Test;
Alimentary Loop Fixation;
Petersen Defect Closure.
This video provides an invaluable resource for surgeons, medical professionals, and enthusiasts interested in the intricacies of Robot-Assisted One Anastomosis Gastric Bypass. Our standardized technique aims to contribute to the advancement of knowledge and skills in the field of bariatric surgery. Embrace innovation and precision in every step of this transformative surgical journey.
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: Inderpal S Sarkaria
This is a video of a 61 year old female with a history of smoking, TIA, and DVT undergoing robotic-assisted right middle lobectomy for a central and FNA-proven lung adenocarcinoma.
DOI: http://dx.doi.org/10.17797/235p3c90cc
Contributors: Ben Biteman, MD
61 year old male with diverticulitis and colovesicular fistula. Patient underwent robotic sigmoid colectomy with takedown of fistula. Firefly used to help identify if fistula still present.
Editor Recruited By: Vincent Obias, MD, MS
DOI# http://dx.doi.org/10.17797/9qxwhlr1q5
David Schwartzberg MD, Tushar Samdani MD, FASCRS, Mario M. Leitao MD, FACOG, FACS, Garrett M. Nash MD, MPH, FACS, FASCRS
Recent data has shown an improved survival with metastasectomy for metastatic rectal cancer. Metastasectomy on a minimally invasive plateform (robotic) can be used for an R0 resection in patients who have retroperitoneal metastasis from rectal cancer after control of the primary tumor.
DOI # http://dx.doi.org/10.17797/wd7d09sjgc
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
Laparoscopic adrenalectomy (LA) was first described by Gagner et al. in the early 1990s, and has since become the gold standard for removal of small and medium sized adrenal tumors.
Most commonly, LA is performed for unilateral benign adrenal lesions, however the minimally invasive technique is also routinely used for bilateral disease, as well as myelolipomas, adrenal cysts, adrenal hemorrhage and androgen-secreting tumors. Compared with the open approach, LA offers shorter hospital stay, improved patient satisfaction, decrease post-operative pain and markedly improved cosmesis. Even more, the difficulty in obtaining adequate open surgical exposure, combined with the diminutive size of the adrenal gland make laparoscopy an especially attractive option. Given this, we decided to proceed with LA approach for our patient who presented with NSCLC metastasis to his right adrenal.
DOI# http://dx.doi.org/10.17797/4ek02iupxd
Mellon MJ, Sethi A, Sundaram CP. Laparoscopic adrenalectomy: Surgical techniques. Indian Journal of Urology : IJU : Journal of the Urological Society of India. 2008;24(4):583-589. doi:10.4103/0970-1591.44277.
Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.
