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Robotic Sigmoid resection for Colovesicular Fistula and use of Firefly

Contributors: Ben Biteman, MD

61 year old male with diverticulitis and colovesicular fistula. Patient underwent robotic sigmoid colectomy with takedown of fistula. Firefly used to help identify if fistula still present. 

Editor Recruited By: Vincent Obias, MD, MS

DOI#  http://dx.doi.org/10.17797/9qxwhlr1q5

Robotic Sigmoid colectomy with use of Firefly and ICG
Diverticulitis and colovesicular fistula
Septic patient
Patient in lithotomy, both arms tucked, on bean bag. Robot set up off patients left hip
Pre colonoscopy showing diverticulitis. Preop CT showing air in bladder consistent with colovesicular fistulay
Bladder, left ureter, sigmoid colon, rectum
Advantages: Robot useful in taking down colovesicular fistula. helps in the difficult dissection between diverticulitis and bladder. Useful in suturing close fistula if patent fistula found. Firefly useful in assessing perfusion of bowel to make sure anastamosis has good perfusion. Robotics have been shown to reduce conversion to open Disadvantages: Various papers show increased operative time and cost of the current Robot.
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Vincent Obias is a consultant for Intuitive Surgical
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