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  • 1. Introduction
  • 2. Surgical Approach
  • 3. Pfannenstiel Incision and Placement of Ports
  • 4. Robot Docking
  • 5. Lateral-to-Medial Colon Mobilization
  • 6. Total Mesorectal Excision (TME) Dissection
  • 7. Determination of Tumor Location and Level of Resection with TilePro and Flexible Sigmoidoscopy
  • 8. Complete Dissection to the Level of Resection
  • 9. Distal Rectal Division with Stapler
  • 10. Dissection of IMA Pedicle
  • 11. Determination and Preparation of Proximal Anastomosis Site
  • 12. Check Perfusion of Colon and Rectal Stump
  • 13. Specimen Extraction Through Pfannenstiel Incision and Proximal Bowel Division
  • 14. Anastomosis with EEA Stapler
  • 15. Air Leak Test for Anastomosis
  • 16. Robot Undocking and Closure
  • 17. Post-op Remarks
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Robotic Low Anterior Resection with Diverting Loop Ileostomy for Locally Advanced Rectal Cancer

4575 views

Jon Harrison, MD1; Todd Francone, MD1,2
1Massachusetts General Hospital
2Newton-Wellesley Hospital

General Surgery
Main TextProcedure OutlineTranscript

Procedure Outline

Table of Contents

  1. 1. Introduction
  2. 2. Surgical Approach
  3. 3. Pfannenstiel Incision and Placement of Ports
  4. 4. Robot Docking
  5. 5. Lateral-to-Medial Colon Mobilization
  6. 6. Total Mesorectal Excision (TME) Dissection
  7. 7. Determination of Tumor Location and Level of Resection with TilePro and Flexible Sigmoidoscopy
  8. 8. Complete Dissection to the Level of Resection
  9. 9. Distal Rectal Division with Stapler
  10. 10. Dissection of IMA Pedicle
  11. 11. Determination and Preparation of Proximal Anastomosis Site
  12. 12. Check Perfusion of Colon and Rectal Stump
  13. 13. Specimen Extraction Through Pfannenstiel Incision and Proximal Bowel Division
  14. 14. Anastomosis with EEA Stapler
  15. 15. Air Leak Test for Anastomosis
  16. 16. Robot Undocking and Closure
  17. 17. Post-op Remarks
  1. Tack Uterus Up and Out of the Way
  1. Recheck Locations with TilePro and Flexible Sigmoidoscopy
  1. Divide IMV
  2. Divide IMA
  1. Place Purse-String Suture for Anvil
  1. Secure Anvil
  2. Insert Stapler and Deploy Spike
  3. Add Purse-String Suture for Distal End
  4. Complete Anastomosis
  5. Oversew Anastomosis
  1. Prepare Diverting Loop Ileostomy Site
  2. Diverting Loop Ileostomy Maturation with Terminal Brooke End