Robotic-assisted Low Anterior Resection with Proximal Colotomy

Contributors: Dr. Jimmy Lin and Dr. Craig Rezac

Robotic surgery offers benefits to both patient and surgeon by allowing smaller incisions with faster recovery time, as well as better accuracy, flexibility and control.  Many procedures which had previously been conducted with laparoscopy, or open surgery, are further improved upon with robotic surgery. This is a video of a robotic-assisted LAR in a male with a T4N2M0 rectal cancer with concern for invasion into the prostate and seminal vesicles. The patient also has a synchronous proximal tubulovillous adenoma which had been biopsied but not completely resected during a previous colonoscopy. He therefore also underwent an intra-operative colotomy and colon polyp resection. This video demonstrates the advantages of robotic-assisted surgery in conjunction with more traditional procedures in order to provide the best care possible for the patient.

Robotic-assisted Low Anterior Resection for Rectal Cancer and Colotomy with Resection of Synchronous Colon Polyp
Carcinoma of the rectosigmoid colon with synchronous proximal colon polyp
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 shoulderCT scan, colonoscopy, cystoscopy, MRI, trans-rectal ultrasound
CT scan, colonoscopy, cystoscopy, MRI, trans-rectal ultrasound
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. Saunders

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