VM50 - Robotic sigmoid colectomy with transvaginal specimen extraction

ONGOING VIDEOS

Location: San Diego Convention Center, ASCRS Connect Lounge, Hall B1/B2, Ground Level

Video Presentation(s)

Sara Myers, MD

Resident
Boston University/Boston Medical Center
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

OB

Olga Beresneva, MD

Assistant Professor of Surgery
Boston Medical Center/Boston University School of Medicine
Boston, MA, United States

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Author(s)

Jennifer Davids, MD, FACS, FASCRS (she/her/hers)

Chief of Colon and Rectal Surgery
Boston Medical Center/Boston University School of Medicinie
Boston University
Boston, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
OS

Olivia Sacks, MD

Surgical Chief Resident
Boston Medical Center/Boston University School of Medicine
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
SR

Samantha Rivard, MD

Colorectal Surgeon
Boston Medical Center
North Reading, Massachusetts, United States

Disclosure information not submitted.
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Katrin Eurich, MD

Assistant Professor
Boston Medical Center
Boston, Massachusetts, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Sara Myers, MD: This individual has no financial relationships with ineligible companies.

Olga Beresneva, MD: This individual has no financial relationships with ineligible companies.

Jennifer Davids, MD, FACS, FASCRS: This individual has no relevant relationships with ineligible companies.

Olivia Sacks, MD: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Natural orifice specimen extraction (NOSE), whereby a specimen is removed through the anus or the vagina rather than through an abdominal incision, is an innovative technique in colorectal surgery for benign indications. Literature suggests benefits of NOSE compared to transabdominal specimen retrieval include lower post-operative analgesia requirements, earlier enteral intake, reduced wound complications, and reduced risk of abdominal wall hernias. NOSE may also be advantageous compared to transabdominal specimen extraction in obese patients, with options of using a wound protector or an endocatch bag in the colpotomy and trimming mesenteric fat off the specimen in benign cases. We present a case of transvaginal extraction of the sigmoid colon, along with pre-operative, intra-operative, and post-operative pearls.

Methods/Interventions: A 50-year old female with recurrent diverticulitis (BMI 35) elected to undergo robotic sigmoid colectomy. We prepped both the rectum and the vagina with betadine. After dissecting the sigmoid colon and stapling proximally and distally, we lifted the uterus with a robotic instrument and an assistant placed a rectal sizer into the vagina. Under tension created by the sizer, we made a 2.5 cm transverse incision on the posterior vaginal wall using robotic scissors. A ringed forceps was introduced through the colpotomy and the sigmoid colon specimen was grasped and guided out through the vagina. We introduced an anvil through the colpotomy prior to closure of the vagina in 2 layers using 2-0 barbed locking suture, and a Baker colorectal anastomosis was performed.

Results/Outcomes: There were no intraoperative complications and the post-operative course was unremarkable. Final pathology revealed chronic diverticulitis.

Conclusion/Discussion: With adherence to proper technique, transvaginal retrieval of the sigmoid colon following robotic resection for diverticular disease is feasible and safe in carefully selected patients.