VM102 - Novel Application New Technology: Single-Port Robotic RectoVaginal Fistula Repair Following Failed Colorectal Anastomosis

ONGOING VIDEOS

Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

Video Presentation(s)

Chris Collier, MD

Resident
Lankenau Medical Center
Philadelphia, PA, United States

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

Author(s)

BW

Brianna Williams, MD (she/her/hers)

Clinical Fellow
Lankenau Medical Center
Philadelphia, PA, United States

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

Suraj Chetty, n/a

Research Assistant
Lankenau Medical Center
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.

Senior Author(s)

JM

John Marks, n/a

Professor
Lankenau Medical Center
Philadelphia, Pennsylvania, United States

All of the relevant financial relationships listed below have been mitigated.
Applied Medical: Consultant (Ongoing); ConMed: Advisor or Review Panel Member (Ongoing); Intuitive Surgical: Consultant (Ongoing); Medtronic: Consultant (Ongoing); Olympus: Consultant (Ongoing); Stryker: Consultant (Ongoing)

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

Chris Collier, MD: This individual has no financial relationships with ineligible companies.

Brianna Williams, MD: This individual has no financial relationships with ineligible companies.

John Marks, n/a: Applied Medical: Consultant (Ongoing); ConMed: Advisor or Review Panel Member (Ongoing); Intuitive Surgical: Consultant (Ongoing); Medtronic: Consultant (Ongoing); Olympus: Consultant (Ongoing); Stryker: Consultant (Ongoing)

Image or Table (Do Not add text here):

Purpose/Background: Traditionally, redo operations are hampered by difficult visualization, instrument reach, and extensive scar tissue. With the use of the SP robot, these challenges are mitigated with a novel technology that aids in addressing complex surgical pathology such as colo-vaginal fistulas. This video covers a case in which a 72 year old female develops late presenting fistula four years after an LAR at another institution for low rectal cancer at 5cm level.

Methods/Interventions: The patient was supine on the OR table. The single-port robot was docked trans-anally. The prior anastomosis and fistula were identified. The dissection was started anterio-laterally just distal to the prior anastomosis and continued circumferentially. The previous anastomotic staple line and fistula were fully resected. The dissection was continued proximally in a circumferential manner to gain sufficient length.
We then transitioned abdominally and finished mobilization laparoscopically. The specimen was freed and the pelvis was then irrigated. ICG confirmed sufficient vascular flow to the colon. The colon was brought out trans-anally. A hand-sewn colo-anal anastomosis was created. The patient was diverted proximally with a diverting ileostomy done in a standard way.

Results/Outcomes: The patient recovered well. Foley was removed on POD2. She regained bowel function and was advanced to a regular diet on POD2. She continued to tolerate a regular diet and was discharged on POD3.

Conclusion/Discussion: With increasing experience utilizing single-port robotics, its use can be expanded to include complex redo procedures. This case is a strong example of complex pathology leveraging the advantages of the SP platform including narrow delivery profile, wristed instruments, and high-resolution imaging.