da Vinci Assisted Extended Right Hemicolectomy and End Ileostomy

da Vinci Assisted Extended Right Hemicolectomy and End Ileostomy

The patient is a 22 year old man with a long standing history of Crohn's Disease causing high grade strictures from his terminal ileum to transverse colon resulting in severe weight loss, difficulty with diet and abdominal discomfort. Given the severity of his disease, and failure of medical management, the patient elected to proceed with a robotic extended right hemicolectomy and end ileostomy. Prior to surgery, patient had a colonoscopy which demonstrated one of the high-grade strictures that did not allow passage of the colonoscope into the proximal transverse colon. This stricture was tattooed at the time of the colonoscopy.

Unstable patients, large phlegmonous mass, obstruction, perforation or ileus leading to massive bowel distension and loss of domain, carcinomatosis, morbid obesity (relative), multiple previous abdominal surgical procedures (relative), extensive abdominal adhesions (relative)

Robotic Surgical System

Patient is placed in the supine position with both arms tucked. The robot is docked on the patient�s right shoulder.
Pre-operative workup

Colonoscopy

White line of Toldt
Right ureter
Hepatic flexure
Duodenum
Pancreatic head

Blood loss, infection, damage to nearby structures (right ureter/kidney, duodenum), stricture, high-output ileostomy

No conflicts to disclose

Courtney M. Townsend, Jr., MD; R. Daniel Beauchamp, MD; B. Mark Evers, MD; and Kenneth L. Mattox, MD, 2012, Sabiston Textbook of Surgery, 19th Edition. Suanders