Techniques in Coloproctology

, Volume 22, Issue 7, pp 557–559 | Cite as

Neurovascular sparing robotic high anterior resection–technical note and video vignette

  • Conor D. WarrenEmail author
  • Auerilius E. R. Hamilton
  • Andrew R. L. Stevenson
Video Forum


Preservation of the inferior mesenteric artery (IMA) during high anterior resection (HAR) for benign disease has been shown to reduce the risk of anastomotic leak and is associated with improved functional outcome [1, 2].

We used the da Vinci Xi™ (dVXi) Robotic System (Intuitive Surgery, Sunnyvale, CA, USA) to perform HAR for diverticular disease with sparing of the IMA, superior rectal artery, and hypogastric nerves. The fundamental points of this robotic neurovascular sparing technique, as opposed to a standard robotic HAR, are a lateral-to-medial mobilisation of the left colon and an early division of the upper rectum before division of the colonic mesentery.

Indocyanine green fluorescence angiography (ICGFA) was used to visually confirm perfusion at anastomotic ends and guide colonic transection level prior to performing stapled anastomosis to help reduce risk of anastomotic leak [3].


The patient in this video is a 68-year-old female who had previously presented...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any research on human participants or animals performed by any of the authors. It describes modification of a technique of an established surgical procedure.

Informed consent

Informed consent has been obtained from the patient involved as well as clearance from the primary treating surgeon.

Supplementary material

Video: Neurovascular sparing robotic high anterior resection technique video (MP4 314424 KB)


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    Cirocchi R, Trastulli S, Farinella E et al (2012) Is inferior mesenteric artery ligation during sigmoid colectomy for diverticular disease associated with increased anastomotic leakage? A meta-analysis of randomized and non-randomized clinical trials. Colorectal Dis 14(9):e521–e529CrossRefPubMedGoogle Scholar
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    Masoni L, Mari FS, Nigri G et al (2013) Preservation of the inferior mesenteric artery via laparoscopic sigmoid colectomy performed for diverticular disease: real benefit or technical challenge: a randomized controlled clinical trial. Surg Endosc 27(1):199–206CrossRefPubMedGoogle Scholar
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    Ris F, Liot E, Buchs NC et al (2018) Multi centre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg 104:11Google Scholar
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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Holy Spirit Northside Private HospitalChermsideAustralia
  2. 2.Department of Colorectal SurgeryThe Royal Brisbane and Women’s HospitalHerstonAustralia
  3. 3.The University of QueenslandHerstonAustralia

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