Difficult Dissection during a Low Anterior Resection

It is well-accepted that recurrent or complicated diverticulitis is an indication for surgical resection. Minimally invasive techniques, like the daVinci robot, have been developed to enable better visualization of the pelvis with articulating instruments. However, many times, the minimally invasive approach is deferred for cases of severe disease and adhesions. This video demonstrates the dissection of a significantly diseased sigmoid colon during a robotic-assisted low anterior resection. As you can see, with surgeon experience and patience, even complicated cases can be done successfully using the robot.

The patient is a 65-year-old male with a history of multiple episodes of diverticulitis. The most recent episode was complicated by a pericolonic abscess, which was treated non-operatively with drainage and antibiotics. He presents 2 months later for an elective resection.

Robotic-assisted low anterior resection
Recurrent or complicated diverticulitis
Contraindications for the robotic approach may include perforation, fecal peritonitis, extensive previous surgery, inability to tolerate pneumoperitoneum
Modified dorsal lithotomy, pre-operative placement of left uretral stent, robot docked at the left, 3 robotic ports and 1 assistant port placement
CT scan of abdomen/pelvis, colonoscopy
Advantages include better visualization of pelvis anatomy with articulating instruments, decreased length of stay post-operatively Disadvantages include longer operative time and increased cost
No disclosures
Thanks to Osvaldo Zumba, MD and Michelle Deleon, MD for their advice and guidance throughout the process
Deleon, Michelle. "Low Anterior Resection for Diverticulitis." Csurgeries.com. Contributor: Craig Rezac. 31 March, 2016.

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