Robotic Colostomy Take-Down

Abstract

Video Objective To demonstrate a surgical video where-in a robotic-assisted colostomy take-down was performed with anastomosis of the descending colon to the rectum after reduction of ventral hernias and extensive lysis of adhesions. Setting Tertiary referral center in New Haven, Connecticut. Interventions This 64-year-old female was diagnosed with Stage IIIA endometrial cancer in 2015 when she underwent an optimal cytoreductive surgery. She required sigmoid resection and a descending end colostomy with Hartmann's pouch, mainly secondary to extensive diverticulitis. Following adjuvant chemoradiation, she remained disease-free and desired colostomy reversal. Imaging was notable for a ventral hernia and a parastomal hernia. Colonoscopy was only notable for narrowing of the distal rectum above the level of the levator ani. Following extensive enterolysis, the splenic flexure of the colon was mobilized to provide an adequate proximal limb to the anastomosis site. The anvil was then introduced into the distal descending colon through the colostomy site. A robotic stapler was utilized in order to seal the colostomy site and detach it from the anterior abdominal wall. Unfortunately, the EEA sizer perforated through the distal rectum, caudad to the stricture site. Thus, a significant length of the distal rectum had to be sacrificed, requiring further mobilization of the splenic flexure. Rectum was then re-approximated with 3-0 barbed suture in two layers. With 6-8cm of distal rectum available, end-to-side anastomosis of descending colon to distal rectum was performed. Given the low colorectal anastomosis, a protective diverting loop ileostomy was then performed. The patient has had an uneventful postoperative course. Hypaque enema performed after three months showed neither anastomotic leak nor stricture. Ileostomy was then reversed. Conclusion Robotic-assisted colostomy take-down and anastomosis were successfully performed. Minimally invasive techniques should be considered as an alternative to laparotomy for patients with colostomy, as long as they are recurrence-free.