Robotic Sigmoidectomy for Diverticulitis – Natural Orifice Extraction with Stapleless Hand‐Sewn Intracorporeal Anastomosis

2021 ◽  
Author(s):  
Omar Yusef Kudsi ◽  
Fahri Gokcal ◽  
Naseem Bou‐Ayash ◽  
Alexandra Chudner
Keyword(s):  
Intracorporeal Anastomosis ◽  
Natural Orifice

scholarly journals Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

2021 ◽  
Author(s):  
Eric M. Haas ◽  
Thais Reif de Paula ◽  
Roberto Luna-Saracho ◽  
Melissa Sara Smith ◽  
Jean-Paul J. LeFave
Keyword(s):  
Complicated Diverticulitis ◽  
Intracorporeal Anastomosis ◽  
Natural Orifice ◽  
Abdominal Incision ◽  
Stepwise Approach ◽  
Stapling Device ◽  
Video Recordings ◽  
Conversion Rates ◽  
Technical Modifications ◽  
Instrument Control

Abstract Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

Robotic Natural Orifice Specimen Extraction with Totally Intracorporeal Anastomosis Associated with Firefly Fluorescence: Bowel Resection for Deep Infiltrating Endometriosis

2020 ◽  
Vol 36 (3) ◽  
pp. 128-135
Author(s):  
Andre Luiz Gioia Morrell ◽  
Gladis Maria P. Anchieta Rodrigues Ribeiro ◽  
Thiago Pareja dos Santos ◽  
Alexander Charles Morrell ◽  
Luciana Pardini Chamie ◽  
...  
Keyword(s):  
Bowel Resection ◽  
Intracorporeal Anastomosis ◽  
Deep Infiltrating Endometriosis ◽  
Natural Orifice ◽  
Specimen Extraction ◽  
Natural Orifice Specimen Extraction ◽  
Infiltrating Endometriosis

Surgical resection for diverticulitis using robotic natural orifice intracorporeal anastomosis and transrectal extraction approach: the NICE procedure

2019 ◽  
Vol 14 (3) ◽  
pp. 517-523 ◽  
Author(s):  
Ramon O. Minjares ◽  
Bertha A. Dimas ◽  
Shadin Ghabra ◽  
Jean-Paul J. LeFave ◽  
Eric M. Haas
Keyword(s):  
Surgical Resection ◽  
Intracorporeal Anastomosis ◽  
Natural Orifice
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