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da Vinci Assisted Extended Right Hemicolectomy and End Ileostomy

Contributors: Jimmy Lin and  Craig Rezac

Robotic surgery offers benefits to both patient and surgeon by allowing smaller incisions and faster recovery time, to better accuracy, flexibility and control.  Many procedures which have previously been conducted with laparoscopy, or open surgery, are becoming further improved in robotic surgery. This video demonstrates once such procedure, the extended right hemicolectomy.

DOI# http://dx.doi.org/10.17797/rv3nkbech0

Authors Recruited By: Vincent Obias. MD. MS

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)
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
Advantages: Superior retraction, visualization and dissection. Disadvantages: Longer procedure time (for robotic setup), potentially more cost
Blood loss, infection, damage to nearby structures (right ureter/kidney, duodenum), stricture, high-output ileostomy
No conflicts to disclose
N/A
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

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