Robotic Low Anterior Resection with Diverting Loop Ileostomy for Locally Advanced Rectal Cancer

1. Introduction

2. Surgical Approach

3. Pfannenstiel Incision and Placement of Ports

4. Robot Docking

5. Lateral-to-Medial Colon Mobilization

1. Tack Uterus Up and Out of the Way

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

1. Recheck Locations with TilePro and Flexible Sigmoidoscopy

9. Distal Rectal Division with Stapler

10. Dissection of IMA Pedicle

1. Divide IMV
2. Divide IMA

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

1. Place Purse-String Suture for Anvil

14. Anastomosis with EEA Stapler

1. Secure Anvil
2. Insert Stapler and Deploy Spike
3. Add Purse-String Suture for Distal End
4. Complete Anastomosis
5. Oversew Anastomosis

15. Air Leak Test for Anastomosis

16. Robot Undocking and Closure

1. Prepare Diverting Loop Ileostomy Site
2. Diverting Loop Ileostomy Maturation with Terminal Brooke End

17. Post-op Remarks