da Vinci Assisted Low Anterior Resection and Colovesical Fistula Repair

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 had previously been conducted with laparoscopy, or open surgery, are becoming further improved upon in robotic surgery. This video demonstrates two such procedures, from different specialities, being performed; the low anterior resection and colovesical fistula repair.

DOI#: http://dx.doi.org/10.17797/f1frvag53q

Robot-Assisted Low Anterior Resection and Colovesical Fistula Repair
Complicated diverticulitis, carcinoma of the rectosigmoid colon higher than 5cm from the anal verge.
Diseased colon less than 5cm from the anal verge, 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
CT scan, colonoscopy, cystoscopy
Bladder, ureters, white line of Toldt, inferior mesenteric vessels, splenic flexure
Advantages: Superior retraction, visualization and dissection Disadvantage: longer procedure/anesthesia time, potentially more cost
Injury to the ureters, spleen, anastomotic leak, bladder leak, blood loss, infection
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

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