Totally Robotic Sigmoidectomy with Trans-anal Specimen Extraction and Intra- corporeal, Single Stapler, End-to-End Anastomosis

The robotic sigmoidectomy dissection was carried out in standard fashion, following which the descending colon and rectosigmoid junction were transected with electrocautery, allowing for a trans-anal specimen extraction. Preoperative bowel preparation limited intra-peritoneal contamination from these maneuvers. An end-to-end anastomotic stapler was introduced through the anus. The anvil was detached intra-corporeally, and both the anvil and stapler body were secured in their respective locations with endoloops prior to firing. Thus, the patient received a totally robotic sigmoidectomy with an intra-corporeal, end-to-end anastomosis, using a single stapler technique.

Indications to proceed with a totally robotic sigmoidectomy with an intra-corporeal, end-to-end anastomosis, using a single stapler technique includes recurrent diverticulitis without evidence of malignancy.

Malignancy extraction via this technique places the patient at risk for seeding along the extraction site.

N/A

Port placement for use with the daVinci XI system includes with 4 ports in a linear fashion spanning from the left upper quadrant to the right lower quadrant with the right lower quadrant being 12mm for the stapler. An additional 12mm AirSeal port is placed in the right upper quadrant for the bed-side assist.

Pre-operatively, mechanical and antibiotic bowel preparation is necessary.

Important anatomy to be aware of is the sigmoid and descending colon, the left ureter, the inferior mesenteric artery pedicle, and the left iliac vessels. Care must be taken during dissection to mobilize and free the inferior mesenteric artery pedicle while protecting the ureter and iliac vessels.

Risks for this surgical procedure include, bleeding, infection, injury to surrounding structures, port-site hernias, adverse cardiac events, deep venous thrombosis, gas embolus, anastomotic leak, ureteral injury, adjacent bowel injury, sepsis, muti-system organ failure, and death.

None of the authors have any financial disclosures with any commercial interest.

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