Robotic right colectomy with intracorporeal anastomosis for malignancy

Techniques for robotic resection of the right colon have not been extensively published or adopted. We report our initial experience of robotic right colectomy with intracorporeal anastomosis and specimen extraction through a Pfannenstiel incision retrospectively. Twenty-one consecutive patients with a right colon cancer (n = 18) or polyp too large to remove endoscopically (n = 3) were treated at Mayo Clinic Rochester, Minnesota. Main outcomes measured were estimated blood loss, operative time, conversion rate, return of gastrointestinal function, length of stay, overall and severe complications, discharge status, and pathology. All 21 procedures were technically successful without the need for conversion. The mean total operative time was 250 ± 56 min, estimated blood loss was less than 100 mL in 19 (90%), only 1 (5%) ileus occurred, mean length of stay and return of gastrointestinal function was 4 ± 1.3 and 1 ± 0.6 days, respectively, only 1 (5%) patient experienced a Dindo grade ≥ 3 complication, and 20 (95%) were discharged to home. Mean number of nodes resected was 26 ± 12. Tumors were diagnosed as stage 0 in 3 (14%), stage I in 7 (33%), stage II in 4 (19%), stage III in 6 (28%), and stage IV in 1 (5%). Main limitations were nonrandomized nature, single institution experience, small patient sample size, and procedures only being performed by two surgeons. Finally, we conclude that robotic right colectomy with central mesocolic excision, intracorporeal anastomosis, and extraction through a Pfannenstiel incision is technically feasible, efficacious, oncologically acceptable, and safe to perform.     

Laparoscopic right colon resection with intracorporeal anastomosis

Background

This study was performed to evaluate short-term clinical outcomes of laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon.

Methods

This was a retrospective study of selected patients who underwent laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon for tumors or Crohn’s disease by a single surgeon from July 2002 through June 2012. Data were retrieved from an Institutional Review Board-approved database. Study end point was postoperative adverse events, including mortality, complications, reoperations, and readmissions at 30 days. Antiperistaltic side-to-side anastomoses were fashioned laparoscopically with a 60-mm-long stapler cartridge and enterocolotomy was hand-sewn intracorporeally in two layers. Values were expressed as medians (ranges) for continuous variables.

Results

There were 243 patients (143 females) aged 61 (range = 19–96) years, with body mass index of 29 (18–43) kg/m² and ASA 1:2:3:4 of 52:110:77:4; 30 % had previous abdominal surgery and 38 % had a preexisting comorbidity. There were 84 ileocolic resections with ileo ascending anastomosis and 159 right colectomies with ileotransverse anastomosis. Operating time was 135 (60–220) min. Estimated blood loss was 50 (10–600) ml. Specimen extraction site incision length was 4.1 (3–4.4) cm. Conversion rate was 3 % and there was no mortality at 30 days, 15 complications (6.2 %), and 8 reoperations (3.3 %). Readmission rate was 8.7 %. Length of stay was 4 (2–32) days. Pathology confirmed Crohn’s disease in 84 patients, adenocarcinoma in 152, and other tumors in 7 patients.

Conclusion

Laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon resulted in a favorable outcome in selected patients with Crohn’s disease or tumors of the right colon.     

Arachnoid cyst associated with pyloric stenosis in a young boy

An unusual association between an arachnoid cyst and a decompensated pyloric stenosis in a three years-old boy is presented. The little patient was admitted into hospital with haematemesis, melena, influenced generally condition and acute posthemorrhagic anaemia following aspirin intake for hypertermia. Specific intensive care was successful and the little patient was discharged but without an upper digestive endoscopy(parents refusal, technical reasons). After one week he returned with progressive worsening vomitings and an intracranial hypertension was suspected. CT documented an arachnoid cyst in the right middle cranial fossa and the patient is directed to the Neurosurgical Clinic where a cyst fenestration was done. Subsequent to operation the vomitings reinstaled with severe dehydration and an upper GI series showed a decompensated pyloric stenosis. He was operated on underwenting an antrectomy. Finally the child recovered with good short and long-term evolution. The coincidental presence of an intracranial congenital mass and a complicated aspirin-induced peptic ulcer in this young patient, misleaded us and in the lack of an early endoscopy an intempestive neurosurgical operation was initially done.     

Laparoscopic resection with intracorporeal anastomosis for colon carcinoma located in the splenic flexure

Background  

Treatment of splenic flexure (SF) colon cancer is not standardized. A laparoscopic approach is considered a challenging procedure.     

Laparoscopic resection of high rectovaginal fistula with intracorporeal colorectal anastomosis and omentoplasty

A 46-year-old Caucasian female underwent vaginal hysterectomy for myoma in another hospital and developed a high rectovaginal fistula 6 weeks later. A diverting-loop colostomy of the sigmoid colon was performed 2 months later. The patient was admitted to our service with persistent high rectovaginal fistula 6 months later. We resected the sigmoid colon and two-thirds of the rectum including the fistula tract using laparoscopic techniques. An intracorporeal anastomosis was accomplished using a double-stapling technique. An omental flap was mobilized and placed between the colorectal anastomosis and the vagina. Except for a subcutaneous wound infection at the former colostomy site, the postoperative course was uneventful. The patient was discharged at the 7th postoperative day and remained free of symptoms. We conclude that laparoscopic resection of high rectovaginal fistula with primary intracorporeal anastomosis is feasible and should be considered in selected cases as an alternative ``minimal-invasive' approach to this disease. Received: 4 December 1995/Accepted: 23 March 1996     

Robotic resection of choledochocele in an adult with intracorporeal hepaticojejunostomy and Roux-en-Y anastomosis: encouraging progress for robotic surgical treatment of biliary disease

Background

Robotic surgery offers three-dimensional visualization and precision of movement that could be of great value to hepatobiliary surgeons. Previous reports of robotic choledochocele resections in adults have detailed extracorporeal jejunojejunostomies. We describe a total robotic excision of a choledochal cyst with hepaticojejunostomy and intracorporeal Roux-en-Y anastomosis.

Methods

A 58-year-old woman underwent a robotic excision of a small choledochocele with hepaticojejunostomy and intracorporeal Roux-en-Y.

Result

Port placement was determined via collaborative surgical discussion and previously reported robotic right hepatectomies. Total operative time was 386 min and total robot working time was 330 min. The hepaticojejunostomy was performed using 5-0 PDS suture with parachute-style back wall and running front wall sutures. The jejunojejunostomy was a stapled anastomosis. Estimated blood loss was less than 100 mL. The patient was ambulating and tolerating oral intake on post-operative day 1, and was discharged home on post-operative day 2.

Conclusions

Robotic resection of choledochal cyst with intracorporeal Roux-en-Y anastomosis is feasible, with advantages over open surgery such as superior visualization, precision, and post-operative patient recovery.     

Pyloric duplication with communication to the pancreas in a neonate simulating hypertrophic pyloric stenosis

An 11-day-old neonate presents with worsening nonbilious emesis and radiographic findings suggestive of pyloric stenosis. Using a laparoscopic approach, a slightly asymmetric and hypertrophied pylorus was visualized. The unusual age of presentation and appearance of the pylorus led to the decision to perform an open exploration for suspicion of a pyloric duplication. An incision of the pyloric muscle exposed and confirmed a duplication cyst. Further exposure revealed accessory pancreatic tissue communicating from the cyst to the main body of the pancreas. The duplication cyst and accessory pancreas were resected, and the patient had an uneventful recovery. Pyloric duplication is a rare cause of congenital extrinsic obstruction in the newborn. Even rarer is a communication of the duplication cyst with the pancreas. Resection of the duplication cyst and the aberrant pancreatic tissue and duct is recommended.     

Robotic resection of an ectopic goiter in the mediastinum

We report the first robotic resection of an ectopic mediastinal thyroid adenoma in a 72-year-old woman. This intervention was part of staged management for excessive bilateral cervical goiter with intrathoracic dispersion. The robotic resection was found to be feasible and safe. The robotic operating system offers better visual control and operative accuracy than does conventional thoracoscopy.     

Rectal resection with colo-anal anastomosis for ergotamine-induced rectal stenosis

Anorectal ulcers due to ergotamine suppositories are extremely rare. We report the first case of rectal stenosis following regular abuse of ergotamine suppositories which required rectal resection and coloanal anastomosis, despite stopping the intoxication 1 year previously. The rectal eversion during the perineal procedure allowed a low anastomosis to be performed, on the dentate line. One year later, the functional result was considered to be good, demonstrating the place of coloanal anastomosis in benign rectal pathology.     

Laparoscopic wedge resection for gastric ectopic pancreas

Ectopic pancreas is pancreatic tissue found outside the usual anatomic location of the pancreas. It is often an incidental finding in clinical practice and can be found at different sites in the gastrointestinal tract. Although usually a silent anomaly, it may become clinically evident when complicated by pathologic changes such as inflammation, bleeding, obstruction, and malignant transformation. We describe a case of ectopic pancreas located in the stomach, treated with a laparoscopic approach that permitted isolation and complete resection of the lesion. The patient was discharged without complications and without recurrence of symptoms.     

Ultrasound diagnosis of pyloric stenosis in young children]

The results of observation of 12 children ranging in age from 1 to 4 mos with tentative diagnosis of pyloric stenosis are presented. The study was performed by special method, using "Aloka" SSD-280 (Japan) ultrasound apparatus. The characteristic symptoms of the disease were revealed in 9 children, diagnosis of pyloric stenosis was confirmed by means of endoscopy, palpation, and intraoperatively. The use of US is practically harmless, and can completely substitute for a roentgenologic method in detecting the given congenital pathology.